Wffti 

I,:- 


A  MANUAL 

OF 

MILITARY  SURGERY; 

<?R, 

HINTS  ON  THE' EMERGENCIES  OF 
FIELD,  CAMP,  AND  HOSPITAL  PRACTICE 

ILLUSTRATED  WITH  WOOD-CUTS. 

BY  S.  D.  (JROSS,  M.D., 

PROF.  OF  SURGERY  IN  THE  JEFFERSON  MEDICAL  COLLEGE  OF  PHILADELPHIA. 

[SECOND  EDITION.] 


"L'oecasion  est  urgente,  le  jugement  difficile." 

"For  want  of  timely  care,  millions  have  died  of  medicable  wounds." 


PHILADELPHIA: 

J.  B.  LIPPINCOTT    &    CO. 

1862. 


TO  1  51 

£7 


LiBRARY 


•••••• .•. 

•  ••  I  •  /  *       •    •       •     •  •    •   • 

•  ••••••;..,       ...        j 


Entered,  according  to  Act  of  Congress,  in  the  year  1861.  by 

J.  B.  LIPPINCOTT  &  CO., 

In  the  Clerk's  Office  of  the  District  Court  of  the  United  States  for  the 
Eastern  District  of  Pennsylvania. 


SAMUEL  WIESSELL  GROSS,  M.D., 

LECTURER  ON  ANATOMY  AND  SURGERY, 
And  one  of  the  Editors  of  the  North  American  Medieo-Chirurgical  Review, 

THIS    LITTLE   VOL.TJ3VIE, 
DESIGNED    TO    MITIGATE    SOME    OF   THE    HORRORS 

OF   THE    CIVIL  WAR 

NOW  IMPENDING  OVER 

OUR    ONCE   HAPPY    AND    GLORIOUS    COUNTRY, 

IS    AFFECTIONATELY    INSCRIBED 

BY 

THE  AUTHOR 


M7860Q 


PREFACE. 


THE  sole  object  which  prompts  me  to  publish  this 
little  book  is  an  ardent  desire  to  be  useful  to  the 
young  physicians  who  have  so  hurriedly  entered  the 
volunteer  service,  perhaps  not  always  with  a  full 
knowledge  of  the  weighty  responsibilities  of  their 
position.  It  treats,  very  succinctly,  of  various  mat- 
ters not  generally  discussed,  except  in  large  and 
ponderous  volumes,  inaccessible  in  the  camp  and  on 
the  battle-field.  It  is  essentially  a  book  for  emergen- 
cies; portable,  easy  of  reference,  always  at  hand. 
The  substance  of  it  was  originally  intended  as  an 
article  for  the  July  number  of  the  NORTH  AMERICAN 
MEDICO-CHIRURGICAL  REVIEW,  and  it  was  not  until 
I  had  made  considerable  progress  in  its  composition 
that  the  idea  suggested  itself  to  my  mind  that  it 
might,  if  published  separately,  be  of  service  to  a 
part  of  my  profession  at  this  particular  juncture  in 
our  public  affairs. 

I  pray  the  young  men  into  whose  hands  this 
Manual  may  happen  to  fall,  to  be  careful  of  the 

(v) 


VI  PREFACE. 

health  and  lives  of  the  poor  soldiers  committed  to 
their  professional  keeping.  I  exhort  them  to  per- 
form their  duty  as  skillful  surgeons  and  physicians, 
as  men  of  courage,  and  as  Christians,  in  order  that, 
when  they  return  to  their  homes  and  their  friends, 
after  the  tumult  and  perils  of  war  shall  be  over — if 
war  there  should  unfortunately  be — they  may  be  able 
to  render  a  good  account  of  their  stewardship,  and 
so  entitle  themselves  to  their  country's  benediction. 

I  would  also  exhort  them,  in  a  special  manner,  to 
take  good  care,  not  only  of  the  lives  of  their  coun- 
trymen, but  also  of  their  limbs,  mutilated  in  battle. 
Conservative  surgery  has,  at  the  present  day,  claims 
of  paramount  importance  upon  the  attention  of  every 
military  practitioner;  for,  in  the  language  of  good 
old  George  Herbert, 

Man  is  all  symmetrie, 
Full  of  proportion,  one  limbe  to  another, 
And  all  to  all  the  world  besides ; 
Each  part  calls  the  furthest  brother; 
For  head  with  foot  hath  private  amitie ; 
And  both  with  moons  and  tides. 

S.  D.  GEOSS. 

PHILADELPHIA,  MAY,  1861. 


CONTENTS. 


PAGE 

DEDICATION 3 


PREFACE  . 


CHAPTER  I. 
Historical  Sketch  of  Military  Surgery 9 

CHAPTER   II. 
Importance  of  Military  Surgery ....  18 

CHAPTER  III. 
Qualifications  and  Duties  of  Military  Surgeons 21 

CHAPTER  IV. 
Medical  Equipments,  Stores  and  Hospitals 27 

CHAPTER  V. 
Wounds  and  other  Injuries 45 

CHAPTER  VI. 
Amputations  and  Resections 74 

CHAPTER  VII. 
Ill  Consequences  of  Wounds  and  Operations ',)0 

(Yii) 


Vili  CONTENTS. 

CHAPTER  VIII.  PAGE 

Injuries  of  the  Head,  Chest,  and  Abdomen 98 

CHAPTER  IX. 
Diseases  Incident  to  Troops 112 

CHAPTER  X. 
Military  Hygiene 139 

CHAPTER  XI. 
Disqualifying  Diseases 151 

CHAPTER  XII. 
Feigned  Diseases 155 

CHAPTER  XIII. 
Medical,  Surgical,  and  Dietetic  Formulae 165 

APPENDIX 183 


A  MANUAL 


MILITARY   SURGERY. 


CHAPTER  I. 
Historical  Sketch  of  Military  Surgery. 

THE  duties  and  requirements  of  military 
are  essentially  similar  to  those  of  civil  sur- 
gery. It  is  founded  upon  the  same  knowl- 
edge of  anatomy,  medicine,  and  the  associate 
sciences;  it  demands  the  same  qualifications, 
physical,  moral,  and  intellectual.  The  differ- 
ence consists  in  the  application  of  our  knowl- 
edge rather  than  in  its  range  or  depth.  The 
civil  surgeon  remains  at  home ;  the  military 
follows  the  army,  examines  recruits  for  the 
public  service,  and  superintends  the  health 
of  the  troops.  If  the  former  is  well  educated, 
he  will  be  quite  as  competent,  at  any  time,  as 


A  .MANUAL   OF 


^  th'e  latter*  to  [perform  these  duties ;  for  the 
\t  •  emfefj^ejicjesjof  civil  'are'  $>f ten  not  less  trying 

*  fhari  tlio's'e  oT  military  practice,  although  they 
may  not  be  on  so  large  a  scale. 

The  best  civil  have  often  also  been  the  best 
military  surgeons.  In  proof  of  this  asser- 
tion it  is  necessary  only  to  refer  to  the  names 
of  Par£,  Wiseman,  Schmucker,  Kern,  Larrey, 
Guthrie,  Charles  Bell,  Alcock,  Thomson,  Bal- 
lingall,  and  Macleod,  of  Europe ;  or  to  those 
of  Rush,  Jones,  Thacher,  Mann,  and  Horner 
of  our  own  country. 

Military  surgery  occupies,  at  the  present 
day,  a  deservedly  high  rank  in  the  estimation 
both  of  the  profession  and  of  the  public.  The 
war  in  the  Crimea,  the  mutiny  in  India, 
and  the  recent  convulsions  in  Italy,  all  at- 
tended with  so  much  waste  of  blood  and  life, 
have  attracted  to  it  the  universal  attention  of 
the  profession ;  and  the  revolutionary  move- 
ments now  in  progress  in  our  own  country 
invest  it  with  a  new  and  a  fearful  interest  to 
every  American  physician.  Its  praises  have 
been  sung  by  Homer,  and,  in  all  ages  of  the 
world,  governments  have  extended  to  it  a 
fostering  hand.  As  a  distinct  branch,  how- 
ever, of  the  healing  art,  it  dates  back  no  fur- 


MILITARY    SURGERY.  11 

ther  than  the  early  part  of  the  sixteenth  cen- 
tury, when  it  was  inaugurated  by  Ambrose 
Par£,  by  the  publication  of  his  treatise  on 
"  Gunshot  Wounds,"  the  fruits  of  his  observa- 
tions in  the  French  army  in  Italy.  This  man, 
who  was  surgeon  to  four  successive  kings,  was 
an  eye-witness  of  the  numerous  French  cam- 
paigns, from  1536  down  to  the  battle  of 
Moncontour,  in  1569,  a  period  of  thirty- 
three  years.  His  popularity,  both  as  a  civil 
and  military  surgeon,  was,  up  to  that  time, 
without  a  parallel.  The  soldiers  worshiped 
him ;  and  the  success  of  more  than  one  siege, 
as  well  of  one  battle,  was  due  almost  exclu- 
sively to  the  wonderful  influence  of  his  pres- 
ence. His  treatise  on  "Gunshot  Wounds" 
appeared  toward  the  middle  of  the  sixteenth 
century,  and,  after  having  passed  through 
various  editions,  was  ultimately  incorporated 
in  his  surgical  writings,  published  nearly  a 
quarter  of  a  century  later. 

In  England,  the  earliest  work  on  military 
surgery  was  that  of  Thomas  Gale,  entitled  a 
"Treatise  on  Gunshot  Wounds,"  designed 
chiefly  to  confute  the  errors  of  some  of  his 
contemporaries,  respecting  the  supposed  pois- 
onous nature  of  these  lesions.  Gale  was  born 


12  A   MANUAL  OP 

in  1507,  and  after  having  served  in  the  army 
of  King  Henry  VIII.,  at  Montrieul,  and  also 
in  that  of  King  Philip,  at  St.  Quintin,  finally 
settled  at  London,  where  he  acquired  great 
distinction  in  his  profession.  In  1639  ap- 
peared the  work  of  J.  Woodall,"  The  Surgeon's 
Mate;  or,  Military  and  Domestic  Surgery." 
He  was  surgeon  under  Queen  Elizabeth,  by 
whom  he  was  sent  to  France,  along  with  the 
troops  that  were  dispatched  to  the  assistance 
of  Henry  IV.  and  Lord  Willoughby.  In 
1676,  Richard  Wiseman,  sergeant-surgeon  to 
King  Charles  II.,  published  his  famous  "Chi- 
rurgical  Treatises,"  one  of  which  was  ex- 
pressly devoted  to  the  consideration  of  gun- 
shot wounds.  Two  years  after  this  a  treatise 
on  gunshot  wounds  was  published  at  London, 
by  John  Brown,  also  surgeon  to  Charles.  He 
was  a  man  of  eminence,  and  served  with  much 
credit  in  the  Dutch  war  of  1665.  The  next 
English  work  on  military  surgery  appeared 
in  1744,  from  the  pen  of  John  Ranby,  ser- 
geant-surgeon to  George  II.,  under  the  title  of 
"  The  Method  of  Treating  Gunshot  Wounds." 
After  Ranby  came  the  imperishable  work  of 
John  Hunter,  familiar  to  every  reader  of  Eng- 
lish surgical  literature.  The  part  relating  to 


MILITARY   SURGERY.  13 

gunshot  wounds  was  founded  upon  his  observ- 
ations made  while  serving  as  staff-surgeon  at 
Belleisle  and  in  Portugal,  and  is  one  of  the 
most  precious  legacies  of  the  last  century, 
near  the  close  of  which  it  appeared. 

The  present  century  has  supplied  quite  a 
number  of  works  on  military  surgery,  as  is 
shown  by  the  valuable  publications  of  Larrey, 
Hennen,  Hecker,  Augustin,  Guthrie,  Thom- 
son, Hutchinson,  Ballingall,  Baudens,  and 
others,  which  have  contributed  so  much  to  the 
elevation  of  this  department  of  the  healing  art. 
Some  of  these  works  have  been  reissued  in  this 
country,  and  have  acquired  a  wide  celebrity. 

We  must  not  forget,  in  this  rapid  enumer- 
ation of  works  on  military  surgery,  the 
"Manuel  de  Chirurgien  d'ArmeV'  of  Baron 
Percy,  published  at  the  commencement  of  the 
revolutionary  war  in  France.  It  is  a  model 
of  what  such  a  treatise  ought  to  be. 

The  only  work  on  this  department  of  sci- 
ence yet  furnished  in  this  country,  is  that  of 
the  late  Dr.  James  Mann,  published  at  Ded- 
ham,  Massachusetts,  in  1816.  It  is  entitled 
"Medical  Sketches  of  the  Campaigns  of 
1812,  '13,  and  '14,"  and  forms  a  closely- 
2* 


14  A   MANUAL   OF 

printed  volume  of  upwards  of  three  hundred 
octavo  pages. 

The  latest  treatise  on  this  subject  in  the 
English  language  is  that  of  Dr.  George  H. 
B.  Macleod,  now  Professor  of  Surgery  at 
Glasgow,  entitled  "  Notes  on  the  Surgery  of 
the  War  in  the  Crimea ;  with  Remarks  on  the 
Treatment  of  Gunshot  Wounds."  It  is  a 
work  of  intense  interest,  written  with  great 
ability  by  an  accurate  and  diligent  observer, 
and  is  worthy  of  a  place  in  every  medical 
library.  To  this  work  frequent  reference  will 
be  made  in  the  following  pages. 

To  Dr.  Lewis  Stromeyer,  Physician  of  the 
Royal  Hanoverian  Army,  we  are  indebted 
for  the  most  recent  German  work  on  military 
surgery.  It  was  issued  in  1858,  under  the 
title  of  "  Maximen  der  Kriegsheilkunst,"  in 
two  duodecimo  volumes,  to  which  a  Supple- 
ment was  added  in  the  early  part  of  the  pres- 
ent year.  A  more  valuable  contribution  to 
this  department  of  surgery  could  hardly  be 
imagined. 

Besides  the  above  more  recent  works,  the 
reader  should  carefully  study  the  "Principles 
of  Military  Surgery,"  by  the  late  Dr.  John 
Hennen,  one  of  the  most  zealous  and  distin- 


MILITARY   SURGERY.  15 

guished  military  surgeons  that  Great  Britain 
has  yet  produced;  a  man  of  vast  experience, 
and  of  the  most  enlightened  views  upon  every- 
thing which  he  has  touched  with  his  pen. 

Perhaps  the  most  systematic  work  on  the 
subject  in  the  English  language  is  that  of  Sir 
George  Ballingall,  entitled  "  Outlines  of  Mil- 
itary Surgery/'  the  last  edition  of  which, 
the  fourth,  appeared  only  recently  at  Edin- 
burgh, where  the  author  held  for  many  years 
the  chair  of  military  surgery,  for  a  long  time, 
we  believe,  the  only  one  in  Great  Britain. 
It  is  a  production  of  much  merit,  and  is  des- 
tined to  maintain  a  very  high  rank  in  this 
species  of  literature. 

The  works  of  the  late  Mr.  George  Guthrie 
also  deserve  attentive  study ;  they  are  written 
with  great  clearness  and  ability,  and  embody 
the  results  of  an  immense  experience,  acquired 
during  many  years  of  arduous  and  faithful 
labor  and  observation  in  the  British  army.  I 
have  always  regarded  the  works  of  this  great 
man  as  among  the  most  valuable  contributions, 
not  only  to  military  surgery,  but  to  surgery 
in  general,  in  the  English  language. 

With  these  works  before  him,  the  student 
of  military  surgery  cannot  fail  to  make  him- 


16  A   MANUAL   OF 

self  in  a  short  time  perfectly  familiar  with 
everything  pertaining  to  the  subjects  of  which 
they  treat.  He  should  also  provide  himself 
with  a  copy  of  the  excellent  little  volume  en- 
titled "  Hints  on  the  Medical  Examination  of 
Recruits  for  the  Army,"  by  the  late  Dr. 
Thomas  Henderson,  formerly  Professor  of 
Medicine  in  Columbia  College,  Washington 
City.  A  new  edition  of  it  was  published  a 
few  years  ago  by  Dr.  Richard  H.  Coolidge, 
of  the  United  States  army. 

Although  we  have  long  had  one  of  the  most 
respectable  and  thoroughly  organized  army 
and  naval  medical  staffs  in  the  world,  our  coun- 
try has,  nevertheless,  not  produced  one  great 
military  surgeon ;  simply,  it  may  be  presumed, 
because  no  opportunity  has  occurred  since  the 
establishment  of  our  government,  in  which  the 
men  in  the  public  service  could  distinguish 
themselves.  Their  aid  has  been  required  in 
the  duello  and  in  skirmishes  rather  than  in 
great  battles,  such  as  have  so  often  charac- 
terized the  movements  of  the  armies  of  the 
Old  World.  We  make  no  exception  in  this 
remark  in  favor  even  of  the  battles  that  were 
fought  during  the  Revolution,  and  during  our 
Late  War,  as  it  has  usually  been  designated, 


MILITARY   SURGERY.  17 

with  Great  Britain.  Those  engagements 
were,  for  the  most  part,  comparatively  blood- 
less. Happily  living  under  a  flag  which, 
until  recently,  commanded  alike  the  respect 
and  the  admiration  of  all  nations,  belonging 
to  a  government  which  was  at  peace  with  all 
foreign  powers,  the  medical  and  surgical  staffs 
of  the  public  service  had  little  else  to  do  than 
to  prescribe  for  such  diseases  as  are  incident 
to  civil  practice.  America  has  never  wit- 
nessed, and  we  trust  in  God  she  never  may 
witness,  such  carnage  as  that  which  attended 
the  footsteps  of  Napoleon  at  the  Bridge  of 
Lodi,  at  Leipzig,  at  Dresden,  and  at  Water- 
loo ;  or  which,  more  recently,  characterized 
the  exploits  of  the  English,  French,  and 
Russian  forces  in  the  Crimea;  or  of  the 
French,  Italian,  and  Austrian  armies  in  Italy ; 
or  of  the  English  soldiers  during  the  late  re- 
bellion in  India.  Nor  has  she  ever  been 
engaged  in  one  great  naval  battle  similar  to 
that  of  La  Hogue,  Toulon,  Trafalgar,  or 
Aboukir.  A  number  of  highly  respectable 
physicians  accompanied  our  army  to  Mexico, 
but  they  returned  without  any  special  laurels, 
and  without  any  substantial  contributions  to 
military  medicine  and  surgery. 


18  A   MANUAL   OP 

CHAPTER  II. 
Importance  of  Military  Surgery. 

IT  is  impossible  for  any  civilized  nation  to 
place  too  high  an  estimate  upon  this  branch 
of  the  public  service.  Without  the  aid  of  a 
properly  organized  medical  staff,  no  army, 
however  well  disciplined,  could  successfully 
carry  on  any  war,  even  when  it  is  one,  as  that 
which  is  now  impending  over  us,  of  a  civil 
character.  No  men  of  any  sober  reflection 
would  enlist  in  the  service  of  their  country, 
if  they  were  not  positively  certain  that  com- 
petent physicians  and  surgeons  would  accom- 
pany them  in  their  marches  and  on  the  field 
of  battle,  ready  to  attend  to  their  diseases 
and  accidents.  Hence  military  surgery,  or, 
more  correctly  speaking,  military  medicine 
and  surgery,  has  always  occupied  a  deservedly 
high  rank  in  public  estimation. 

Dionis,  a  surgeon  far  in  advance  of  his 
age,  in  referring  to  the  value  of  medical  ser- 
vices to  soldiers,  exclaims,  with  a  burst  of 
eloquence:  "We  must  then  allow  the  neces- 


MILITARY    SURGERY.  19 

sity  of  chirurgery,  which  daily  raises  many 
persons  from  the  brink  of  the  grave.  How 
many  men  has  it  cured  in  the  army !  How 
many  great  commanders  would  have  died  of 
their  ghastly  wounds  without  its  assistance ! 
Chirurgery  triumphs  in  armies  and  in  sieges. 
'Tis  true  that  its  empire  is  owned:  'tis  there 
that  its  effects,  and  not  words,  express  its 
eulogium." 

The  confidence  reposed  by  soldiers  in  the 
skill  and  humanity  of  their  surgeon  has  often 
been  of  signal  service  in  supporting  them, 
when  exhausted  by  hunger  and  fatigue,  in 
their  struggles  to  repel  the  advancing  foe,  or 
in  successfully  maintaining  a  siege  when  the 
prospect  of  speedy  surrender  was  at  hand. 
Who  that  is  versed  in  the  history  of  our  art 
does  not  remember  with  what  enthusiasm  and 
resolve  Ambrose  Par£,  the  father  of  French 
surgery,  inspired  the  souls  of  the  half-starved 
and  desponding  garrison  at  Metz,  in  1552, 
when  besieged  by  100,000  men  under  the 
personal  command  of  Charles  V.?  Sent 
thither  by  his  sovereign,  he  was  introduced 
into  the  city  during  the  night  by  an  Italian 
captain;  and  the  next  morning,  when  he 


20  A    MANUAL   OF 

showed  himself  upon  the  breach,  he  was 
received  with  shouts  of  welcome.  "We  shall 
not  die,"  the  soldiers  exclaimed,  "even  though 
wounded;  Par£  is  among  us."  The  defense 
from  this  time  was  conducted  with  renewed 
vigor,  and  the  French  army  ultimately  com- 
pletely triumphed,  through  the  sole  influence 
of  this  illustrious  surgeon. 

No  man  in  the  French  army  under  Napo- 
leon rendered  so  many  and  such  important 
services  to  the  French  nation  as  Larrey,  the 
illustrious  surgeon  who  accompanied  that 
mighty  warrior  in  his  various  campaigns, 
everywhere  animating  the  troops  and  doing 
all  in  his  power  to  save  them  from  the  de- 
structive effects  of  disease  and  injury.  His 
humanity  and  tenderness  were  sublime ;  and 
so  highly  was  his  conduct,  as  an  honest,  brave, 
and  skillful  surgeon,  appreciated  by  Napoleon, 
that  he  bequeathed  him  a  large  sum,  with  the 
remark  that  "Larrey  was  the  most  virtuous 
man  he  had  ever  known." 


MILITARY   SURGERY.  21 

% 

CHAPTER  III. 
Qualifications  and  Duties  of  Military  Surgeons. 

IT  is  of  paramount  importance  that  none 
but  men  of  the  best  talent  and  of  the  highest 
education  should  be  received  into  the  public 
service.  Rigid  as  the  examinations  of  the 
army  and  naval  medical  boards  already  are, 
there  is  need  of  increased  rigor,  in  order  that 
none  may  be  admitted  who  are  not  thoroughly 
prepared  for  the  discharge  of  their  responsi- 
ble duties.  Equal  vigilance  should  be  exer- 
cised in  regard  to  the  introduction  of  physi- 
cians and  surgeons  into  the  volunteer  service. 
Every  regiment  should  be  provided  with  an 
able  medical  head,  a  man  ready  for  every 
emergency,  however  trying  or  unexpected; 
a  man  skilled  in  the  diagnosis  and  treatment 
of  diseases,  and  competent  to  perform  any 
operation,  whether  small  or  large,  on  the  spur 
of  the  moment.  To  do  this,  he  must  be  more 
than  a  mere  physician ;  he  must  be  both  phy- 
sician and  surgeon,  in  the  true  sense  of  the 
terms,  otherwise  he  will  be  unfit,  totally  un- 
3 


22  A   MANUAL   OP 

fit,  for  his  position*  He  must  have  been 
educated  in  the  modern  schools ;  be  of  un- 
doubted courage,  prompt  to  act,  willing  to 
assume  responsibility,  humane  and  sympa- 
thizing, urbane  and  courteous  in  his  manners; 
in  short,  a  medical  gentleman,  as  well  as  a 
medical  philosopher, — not  hesitating,  if  need 
be,  to  perform  the  most  menial  services,  and 
to  do  all  he  can  to  preserve  the  health  and 
the  lives  of  the  soldiers  committed  to  his  care. 
The  white-gloved  gentry,  such  as  figured  in 
some  of  the  regiments  that  went  to  Mexico, 
have  no  business  in  the  service;  their  time 
can  be  much  better  spent  in  the  discharge  of 
their  domestic  duties,  in  the  practice  of  their 
neighborhood,  and  in  the  contemplation,  at  a 
distance,  of  the  miseries  of  war. 

It  is  much  to  be  feared  that,  from  the  rapid 
manner  in  which  our  volunteers  have  been  hur- 
ried together,  many  medical  men,  old  as  well 
as  young,  have  already  been  admitted  into  the 
service  utterly  unfit  for  the  office.  If  this  be 
the  case,  let  our  authorities,  warned  by  the 
past,  be  more  circumspect  in  regard  to  the 
future.  Above  all,  let  them  see  that  the 
medical  staffs  of  the  brave  volunteers  of  the 
country  be  not  defiled  by  charlatans  and  un- 


MILITARY   SURGERY.  23 

worthy  men,  between  whom  and  the  regular 
practitioners  there  cannot  possibly  be  any 
professional,  much  less  social  intercourse, 
either  in  civil  or  military  practice.  The  me- 
dical men  should  be  on  the  best  possible  terms 
with  each  other;  all  causes  of  discord  and 
bickering  among  themselves  should  be  stu- 
diously obviated,  and  speedily  suppressed,  if, 
unfortunately,  they  should  arise.  Concert  of 
action  on  the  part  of  the  medical  corps  is  in- 
dispensable to  the  success  of  the  medical 
operations  of  an  army. 

Every  regimental  surgeon  should  have  at 
least  two  assistants  in  time  of  peace,  or 
during  the  inactivity  of  the  troops  under  his 
charge;  when  on  active  duty,  on  the  con- 
trary, the  number  should  at  least  be  double, 
especially  in  the  face  of  an  anticipated  bloody 
engagement.  These  assistants  should  be  se- 
lected solely  with  reference  to  their  compe- 
tency; they  should,  like  the  principal,  be 
eminently  intelligent,  and  ready,  in  case  of 
emergency,  to  perform  any  operation  that 
occasion  may  demand.  Every  brigade  should 
have  its  brigade  surgeon,  who  should  exercise 
a  supervisory  control  over  the  regimental 
surgeons,  principals  as  well  as  assistants,  as 


24  A   MANUAL   OF 

every  State  should  have  its  surgeon-general, 
or  medical-director,  whose  duty  it  should  be  to 
superintend  the  whole  medical  arrangements, 
seeing  that  the  candidates  for  the  medical  de- 
partment of  the  service  be  subjected  to  a  rigid 
examination,  attending  to  the  purchase  of 
medicines  and  instruments,  providing  suitable 
nurses,  inspecting  the  quarters,  stores,  and  pro- 
visions,' that  nothing  of  an  unwholesome  char- 
acter may  find  its  way  into  the  ranks,  pointing 
out  the  proper  location  of  camps,  and  the  con- 
struction of  hospitals,  and  giving  general  in- 
structions in  regard  to  military  hygiene,  or  the 
best  means  of  avoiding  disease  and  accident. 
Prior  to  every  engagement  at  all  likely  to 
be  severe  or  serious,  a  proper  number  of  men 
should  be  detailed  for  the  purpose  of  render- 
ing prompt  assistance  to  the  wounded,  and 
carrying  them  off  the  field  of  battle  to  the 
hospitals  or  tents  erected  for  their  accommo- 
dation and  treatment.  Unless  this  be  done 
as  a  preliminary  step,  much  suffering  will  in- 
evitably be  the  consequence,  if  not  great  con- 
fusion, highly  prejudicial  to  the  issue  of  the 
combat.  So  fully  aware  are  the  leaders  and 
sub-commanders  of  our  armies  of  this  fact 
that  they  never  permit  any  man  to  fall  out 


MILITARY   SURGERY.  25 

of  the  ranks,  during  an  engagement,  to  per- 
form this  service. 

While  the  battle  is  progressing  it  is  the  duty 
of  the  surgeon  and  of  his  assistants  to  remain 
in  the  rear  of  the  combatants,  as  much  as  pos- 
sible out  of  harm's  way,  but  at  the  same  time 
ready  and  on  the  watch  to  render  the  promptest 
possible  aid.  They  must  be  Argus-eyed,  and 
in  the  full  possession  of  their  wits.  One  of 
the  leading  differences  between  military  and 
civil  practice  is  the  instantaneous  action  so 
often  demanded  by  the  one,  and  the  delay  so 
frequently  admitted  by  the  other. 

The  first  duty  of  every  surgeon  is  to  the 
officers  and  men  of  his  own  corps;  but  on 
the  field  of  battle,  or  soon  after  the  battle  is 
over,  he  is  often  brought  in  contact  with  the 
members  of  other  regiments,  or  even  with  the 
wounded  of  the  enemy ;  and  under  such  cir- 
cumstances the  dictates  of  humanity,  not  less 
than  the  usages  of  war,  demand  that  he  should 
render  his  services  wherever  they  may  be 
likely  to  be  useful.  The  medical  officers, of 
the  contending  parties  sometimes  meet  upon 
such  occasions,  and,  when  this  is  the  case, 
their  conduct  should  invariably  be  char  act  er- 
3* 


26  A   MANUAL   OF 

ized  by  the  courtesy  of  the  gentleman,  not  the 
asperity  of  the  enemy.  They  should  not  for- 
get that  they  are  brethren  of  the  same  noble 
profession,  acting  in  the  capacity  of  minister- 
ing angels  to  the  sick  and  the  dying.  Coun- 
try and  cause  alike  should  be  forgotten  in  gene- 
rous deeds. 

By  the  usages  of  war  in  all  civilized  coun- 
tries, the  surgeons  are  always  respected  by 
the  enemy  if,  during  an  engagement,  they 
happen  to  fall  accidentally  into  their  hands. 
Their  lives  are  regarded  as  sacred,  the  more 
so,  as  they  are  comparatively  defenseless. 
They  are  not,  however,  during  the  rage  and 
smoke  of  the  battle-field,  always  easily  distin- 
guishable from  the  other  officers,  or  even  the 
common  soldiers.  The  green  sash,  their  dis- 
tinctive badge  of  office,  does  not  always  afford 
them  immunity,  because  it  is  not  always  re- 
cognized; and  it  is  worthy  of  consideration 
whether,  as  an  additional  safeguard,  the  word 
"  surgeon"  should  not  be  embroidered  in  legi- 
ble characters  upon  a  piece  of  cloth,  to  be 
thrown  across  the  chest  in  time  of  battle. 
The  significance  of  such  a  badge  could  not  be 
mistaken  by  friend  or  foe,  and  would  be  the 
means  of  saving  many  valuable  lives. 


MILITABY    SURGERY.  2? 


CHAPTER  IV. 
Medical  Equipments,  Stores,  and  Hospitals, 

EVERY 'regiment,  or  body  of  military  men, 
should  be  amply  provided,  in  time  of  war, 
with  the  means  of  conveying  the  wounded 
and  disabled  from  the  field  of  battle.  For 
this  purpose  suitable  carriages  and  litters 
should  constantly  be  in  readiness.  The  car- 
riages should  be  built  in  the  form  of  light 
wagons,  drawn  each  by  two  horses ;  with 
low  wheels,  easy  springs,  and  a  large,  wide 
body,  furnished  with  a  soft  mattress  and  pil- 
lows, and  capable  of  accommodating  not  less 
than  eight  or  ten  persons,  while  arrangements 
might  be  made  at  the  side  for  seating  a  num- 
ber more,  as  in  the  French  voiture.  As  a 
means  of  protection  against  the  sun  and  the 
rain,  it  should  have  a  light  cover  of  oil-cloth 
or  canvas. 

A  great  number  of  litters,  or  bearers,  will 
be  found  described  in  treatises  on  military 
surgery ;  but  I  am  not  acquainted  with  any 


28  A   MANUAL   OF 

which  combine  so  much  simplicity  and  cheap- 
ness, with  lightness  and  convenience,  as  one 
which,  after  a  good  deal  of  reflection,  I  have 
just  devised,  and  of  which  the  accompanying 
sketch  affords  a  good  illustration.  It  consists 
of  two  equal  parts,  connected 
at  the  ends  by  stout  hinges, 
the  arrangement  being  such  as 
to  permit  of  their  being  folded 
for  more  easy  transportation 
on  the  field  of  battle.  Each 
part  has  a  side  piece  of  wood, 
three  feet  four  inches  long,  by 
two  inches  in  depth,  and  an 
inch  and  a  half  in  thickness, 
the  free  extremity  terminating 
in  a  slightly  curved  handle. 
The  side  pieces  are  united  by 
four  traverses,  and  the  entire 
frame  is  covered  with  ducking, 
twenty  -four  inches  in  width.  Thus  constructed, 
the  apparatus  is  not  only  very  light,  so  that 
any  one  may  easily  carry  it,  or,  indeed,  even 
three  or  four  at  a  time,  but  remarkably  con- 
venient both  for  the  transportation  of  pa- 
tients, and  for  lifting  them  in  and  out  of  the 


MILITARY   SURGERY.  29 

wagons,  which  should  always  be  at  hand 
during  an  engagement.  Moreover,  by  means 
of  side  straps,  provided  with  buckles,  it  will 
answer  extremely  well  for  a  bed-chair,  so  ne- 
cessary in  sickness  and  during  convalescence, 
the  angle  of  flexion  of  the  two  pieces  thus 
admitting  of  ready  regulation.  In  carrying 
the  wounded  off  the  field,  the  labor  may 
easily  be  performed  by  two  men,  especially 
if  they  use  shoulder-straps  to  diffuse  the 
weight  of  the  burden.  The  body,  in  hot 
weather,  might  be  protected  with  an  oil- 
cloth, while  the  face  might  be  shielded  from 
the  sun  with  a  veil  or  handkerchief.  A  pil- 
low for  the  head  can  be  made  with  the  coat 
of  one  of  the  carriers. 

Besides  these  means,  every  regiment  should 
be  furnished  with  an  ambulance,  or,  as  the 
term  literally  implies,  a  movable  hospital,  that 
is,  a  place  for  the  temporary  accommodation 
and  treatment  of  the  wounded  on  the  field  of 
battle.  It  should  be  arranged  in  the  form  of 
a  tent,  and  be  provided  with  all  the  means 
and  appliances  necessary  for  the  prompt  suc- 
cor of  the  sufferers.  The  materials  of  which  it 
consists  should  be  as  light  as  possible,  possess 


30  A   MANUAL   OP 

every  facility  for  rapid  packing  and  erection, 
and  be  conveyed  from  point  to  point  by  a 
wagon  set  apart  for  this  object.  The  ambu- 
lance, for  the  invention  and  improvement 
of  which  we  are  indebted  to  two  eminent 
French  military  surgeons,  Percy  and  Lar- 
rey,  is  indispensable  in  every  well-regulated 
army. 

This  temporary  hospital  should  be  placed 
in  an  open  space,  convenient  to  water,  and 
upon  dry  ground,  with  arrangements  for  the 
free  admission  of  air  and  light,  which,  next 
to  pure  air,  is  one  of  the  most  powerful  stim- 
ulants in  all  cases  of  accident  attended  with 
excessive  prostration.  The  direct  rays  of  the 
sun,  in  hot  weather,  must  of  course  be  ex- 
cluded, and  it  may  even  be  necessary,  as  in 
injuries  of  the  head  and  eye,  to  wrap  the 
patient  in  complete  darkness.  A  properly- 
regulated  temperature  is  also  to  be  main- 
tained, a  good  average  being  about  68°  of 
Fahrenheit's  thermometer. 

As  engagements  are  sometimes  begun  after 
dark,  or  are  continued  into  the  night,  an  ade- 
quate supply  of  wax  candles  should  be  provided, 
as  they  will  be  found  indispensable  both  in  field 


MILITARY   SURGERY.  31 

and  hospital  practice  in  performing  operations 
and  dressing  wounds  and  fractures.  Torches, 
too,  will  frequently  be  needed,  especially  in 
collecting  and  transporting  the  wounded. 
Bed-pans,  feeding-cups,  spoons,  syringes,  and 
other  appliances  usually  found  in  the  sick 
chamber,  will  form  a  necessary  part  of  the 
furniture  of  such  an  establishment. 

The  object  of  the  ambulance  is,  as  already 
stated,  to  afford  prompt  succor  to  the  wounded. 
Here  their  lighter  injuries  are  speedily  dressed, 
and  the  more  grave  subjected  to  the  operations 
necessary  for  their  cure.  In  due  time,  the 
former  are  sent  back  to  the  ranks,  while  the 
rest  are  conveyed  to  suitable  lodgings  or  to 
permanent  hospitals. 

As  soon  as  practicable,  after  the  hurry  and 
confusion  attendant  upon  a  combat  are  over, 
the  surgeon  should  classify  the  wounded  and 
disabled,  taking  care  that  those  laboring  under 
similar  lesions  are  not  brought  in  close  con- 
tact; lest,  witnessing  each  other's  sufferings, 
they  should  be  seized  with  fatal  despond- 
ency. 

Larrey,  in  order  to  meet  the  exigencies  of 
the  grand  army  in  Italy,  constructed  a  flying 


32  A  MANUAL  OF 

ambulance;  an  immense,  and,  at  first  sight,  a 
very  cumbersome  establishment.  It  consisted 
of  twelve  light  wagons,  on  easy  springs,  for 
the  transportation  of  the  wounded ;  some  with 
two,  others  with  four  wheels.  The  frame  of 
the  former,  which  were  designed  for  flat,  level 
countries,  resembled  an  elongated  cube,  curved 
on  the  top ;  it  had  two  small  windows  on  each 
side,  with  a  folding-door  in  front  and  behind. 
The  floor  of  the  body,  separable  and  movable 
on  rollers,  was  covered  with  a  mattress  and 
bolster.  Handles  were  secured  to  it  laterally, 
through  which  the  sashes  of  the  soldiers  were 
passed  in  lifting  the  sick  in  and  out  of  the 
carriage,  when,  on  account  of  the  weather, 
their  wants  could  not  be  relieved  on  the 
ground.  Each  vehicle  was  thirty-two  inches 
wide,  and  was  drawn  by  two  horses ;  it  could 
conveniently  accommodate  two  patients  at  full 
length,  and  was  furnished  with  several  side- 
pockets  for  such  articles  as  might  be  needed 
for  the  sufferers. 

The  large  carriage,  drawn  by  four  horses, 
and  designed  for  rough  and  hilly  roads,  was 
constructed  upon  the  same  principle  as  the 
small ;  it  had  four  wheels,  and  could  accom- 


MILITARY   SURGERY.  33 

modate  four  persons.  The  left  side  of  the 
body  had  two  long  sliding-doors,  extending 
almost  its  whole  length,  so  as  to  permit  the 
wounded  to  be  laid  in  a  horizontal  position. 

These  carriages  were  used  for  conveying  the 
wounded  from  the  field  of  battle  to  the  hospi- 
tals of  the  lines,  and  combined,  it  is  said, 
solidity  with  lightness  and  elegance. 

The  number  of  men  attached  to  the  flying 
ambulance  was  113,  embracing  a  soldier's 
guard  with  twelve  men  on  horseback,  a 
quartermaster-general,  a  surgeon-major,  with 
his  two  assistants  and  twelve  mates,  a  police 
officer,  and  a  number  of  servants.  The  flying 
ambulance  was,  in  fact,  a  costly  and  imposing 
establishment,  devised  by  the  humanity  and 
ingenuity  of  the  great  and  good  Larrey,  who 
could  never  do  too  much  for  the  wounded  sol- 
dier, and  whose  presence,  like  that  of  his  illus- 
trious countryman,  Par£,  always  served  to 
animate  the  French  troops.  At  one  time 
three  divisions  of  the  flying  ambulance, 
equipped  upon  this  grand  scale,  were  upon 
the  field  in  different  parts  of  Italy. 

It  is  not  deemed  necessary,  in  a  work  like 
this,  to  give  an  account  of  the  construction  of 
4 


34  A   MANUAL   OF 

hospitals,  properly  so  termed ;  for,  with  the 
railroad  and  steamboat  facilities  which  we  now 
possess,  there  can  be  little  difficulty  in  obtain- 
ing comfortable  accommodations  for  the  sick 
and  wounded,  soldiers.  Lodgings  can  almost 
always  be  procured,  in  nearly  every  portion 
of  the  country  where  a  battle  is  likely  to  be 
fought,  in  houses,  churches,  and  barns.  Tem- 
porary sheds  might  easily  be  erected  in  a  few 
hours,  with  such  arrangements  as  would  serve 
for  the  more  pressing  wants  of  the  wounded. 
The  chief  points  to  be  attended  to,  in  their 
construction,  are  sufficient  elevation  of  the 
ground  floor  for  the  free  circulation  of  air, 
windows  for  light  and  ventilation,  and  such  a 
position  of  the  fire-place  as  not  to  annoy  the 
inmates. 

The  medical  stores  of  the  military  hospital, 
whether  temporary  or  permanent,  include 
medicines,  instruments,  and  various  kinds  of 
apparatus,  as  bandages,  oiled  silk,  and  splints. 

It  would  far  transcend  my  limits  were  I  to 
enter  fully  into  all  the  details  connected  with 
these  different  topics.  A  few  brief  remarks 
under  each  head  must  suffice  for  my  purpose. 

1st.  In  regard  to  medicines,  a  few  articles 


MILITARY    SURGERY.  35 

only,  well  selected  and  arranged  for  ready 
use,  will  be  necessary.  It  is  bad  enough,  in 
all  conscience,  for  a  man  to  be  severely  shot 
or  stabbed,  without  physicking  him  to  death. 
Let  him  by  all  means  have  a  chance  for  his 
life,  especially  when  he  has  already  been 
prostrated  by  shock  and  hemorrhage.  Food 
and  drink,  with  opium  and  fresh  air,  will 
then  do  him  more  good  than  anything  else. 
I  shall  enumerate  the  medicines  upon  which, 
in  my  judgment,  most  reliance  is  to  be  placed 
in  this  kind  of  practice,  according  to  their 
known  effects  upon  the  system. 

1.  Anodynes : — opium,  morphia,  and  black 
drop,  or  acetated  tincture  of  opium. 

2.  Purgatives: — blue  mass,  colomel,  rhu- 
barb, jalap,  compound  extract  of  colocynth, 
and  sulphate  of  magnesia.     Some  of  these 
articles   should   be  variously  combined,  and 
put  up  in  pill  form  for  ready  use. 

3.  Depressants  : — tartrate  of  antimony  and 
potassa,  ipecacuanha,  and  tincture  of  vera- 
trum  viride. 

4.  Diaphoretics  : — antimony,  ipecacuanha, 
nitrate   of    potassa,    morphia,    and    Dover's 
powder. 


36  A  MANUAL   OF 

5.  Diuretics: — nitrate   and   carbonate   of 
potassa,  and  colchicum. 

6.  Antiperiodics : — quinine  and  arsenic. 

7.  Anaesthetics : — chloroform  and  ether. 

8.  Stimulants: — brandy,    gin,   wine,    and 
aromatic  spirits  of  ammonia. 

9.  Astringents  : — acetate  of  lead,  perchlo- 
ride  of  iron  and  alum,  tannin,  gallic  acid,  and 
nitrate  of  silver. 

10.  Escharotics  : — nitric  acid,  acid  nitrate 
of  mercury,  (Bennett's  formula,)  and  Vienna 
paste. 

2d.  The  surgical  armamentarium  should  also 
be  as  simple  as  possible.  It  should  embrace 
a  small  pocket  case,  with  a  screw  catheter ;  a 
full  amputating  case,  with  at  least  three 
tourniquets,  two  saws  of  different  sizes,  and 
several  large  bone-nippers ;  and,  lastly,  a 
trephining  case.  Several  silver  catheters  of 
different  sizes,  a  stomach  pump,  small  and 
large  syringes,  feeding-cups  and  bed-pans 
should  also  be  put  up. 

3d.  Under  the  head  of  apparatus  may  be 
included  bandages,  lint,  linen,  adhesive  plas- 
ter, splints,  cushions,  wadding,  and  oiled  silk. 

The  bandages,  composed  of  tolerably  stout 


MILITARY   SURGERY.  37 

muslin,  should  be  free  from  starch  and  selvage, 
well  rolled,  and,  on  an  average,  from  two 
inches  and  a  quarter  to  two  inches  and  a  half 
in  width  by  eight  yards  in  length.  The 
bandage  of  Scultetus,  very  serviceable  in 
compound  fractures,  can  easily  be  made,  as 
occasion  may  require,  out  of  pieces  of  the 
common  roller. 

Of  lint,  the  patent,  or  apothecary's,  as  it  is 
termed,  is  the  best,  as  it  is  soft  and  easily 
adapted  to  the  parts  to  which  it  is  intended 
to  be  applied.  Old  linen  or  muslin  also  an- 
swers sufficiently  well.  Charpie  is  now  sel- 
dom used. 

An  abundance  of  adhesive  plaster,  put  up 
in  small  cases,  should  be  provided.  Collo- 
dion will  not  be  necessary. 

Splints,  of  binders  or  trunk-makers'  board, 
and  of  light  wood,  should  find  a  place  in  every 
medical  store,  as  frequent  occasions  occur  for 
their  use.  In  fractures  of  the  lower  ex- 
tremity special  apparatus  may  be  required, 
which, -however,  as  it  is  cumbrous  and  incon- 
venient to  carry,  may  generally  be  prepared 
as  it  is  needed. 

Cushions  are  made  of  muslin,  sewed  in  the 
4* 


38  A  MANUAL   OF 

form  of  bags,  of  variable  size  and  shape,  and 
filled  with  cotton,  tow,  saw-dust  or  sand.  They 
are  designed  to  equalize  and  ward  off  pres- 
sure in  the  treatment  of  fractures  of  the  lower 
extremities. 

Wadding  is  a  most  valuable  article  in  sur- 
gical practice,  both  for  lining  splints  and 
making  pads,  as  well  as  in  the  treatment  of 
burns  and  scalds,  and  cannot  be  dispensed 
with. 

Oiled  silk  is  a  prominent  article  in  the 
dressings  of  the  present  day ;  it  preserves 
the  heat  and  moisture  of  poultices  and  of 
warm  water-dressings,  at  the  same  time  that 
it  protects  the  bed  and  body-clothes  of  the 
patient. 

Oil-cloth,  soft  and  smooth,  is  required  in 
all  cases  of  severe  wounds  and  fractures,  at- 
tended with  much  discharge. 

Air-cushions  should  be  put  up  in  consid- 
erable numbers,  as  their  use  will  be  indis- 
pensable in  all  cases  of  disease  and  injury 
involving  protracted  confinement. 

Bran  and  saw-dust  will  be  found  of  great 
value  in  the  treatment  of  compound  fractures, 
ulcers,  gangrene,  and  suppurating  wounds,  as 


MILITARY    SURGERY.  39 

an  easy  support  for  the  injured  limb  and  a 
means  of  excluding  flies. 

Medical  case-books  should  be  put  up  along 
with  the  other  articles,  for  the  accurate  regis- 
tration of  the  names  of  the  sick  and  wounded, 
the  nature  of  their  lesions,  and  the  results  of 
treatment.  The  medical  officers  should  also 
keep  a  faithful  record  of  the  state  of  the 
weather,  the  temperature  of  the  air,  the  na- 
ture of  the  climate,  the  products  of  the  soil, 
and  the  botany  of  the  country  through  which 
they  pass  or  in  which  they  sojourn,  together 
with  such  other  matters  as  may  be  of  profes- 
sional or  scientific  interest.  The  knowledge 
thus  acquired  should  be  disseminated  after 
their  return  for  the  benefit  of  their  profes- 
sional brethren. 

Finally,  in  order  to  complete  hospital  equip- 
ments, well-trained  nurses  should  be  provided ; 
for  good  nursing  is  indispensable  in  every 
case  of  serious  disease,  whatever  may  be  its 
character.  The  importance  of  this  subject, 
however,  is  now  so  well  appreciated  as  not  to 
require  any  special  comments  here. 

The  question  as  to  whether  this  duty  should 
be  performed  by  men  or  women  is  of  no  ma- 


40  A  MANUAL   OF 

terial  consequence,  provided  it  be  well 
done.  The  eligibility  of  women  for  this 
task  was  thoroughly  tested  in  the  Crimea, 
through  the  agency  of  that  noble-hearted 
female,  Florence  Nightingale;  and  hundreds 
of  the  daughters  of  our  land  have  already 
tendered  their  services  to  the  government  for 
this  object.  No  large  and  well-regulated 
hospital  can  get  on  without  some  male  nurses, 
and  they  are  indispensable  in  camp  and  field 
practice. 

It  is- not  my  purpose  here  to  point  out  the 
qualities  which  constitute  a  good  female  nurse. 
It  will  suffice  to  say  that  she  should  be  keenly 
alive  to  her  duties,  and  perform  them,  how- 
ever menial  or  distasteful,  with  promptness 
and  alacrity.  She  must  be  tidy  in  her  ap- 
pearance, with  a  cheerful  countenance,  light 
in  her  step,  noiseless,  tender  and  thoughtful 
in  her  manners,  perfect  mistress  of  her  feel- 
ings, healthy,  able  to  bear  fatigue,  and  at 
least  twenty-two  years  of  age.  Neither  the 
crinoline  nor  the  silk  dress  must  enter  into 
her  wardrobe ;  the  former  is  too  cumbrous, 
while  the  latter  by  its  rustling  is  sure  to  fret 
the  patient  and  disturb  his  sleep.  Whisper- 


MILITARY   SURGERY.  41 

ing  and  walking  on  tiptoe,  as  has  been  truly 
observed  by  Florence  Nightingale,  are  an 
abomination  in  the  sick  chamber.  Finally, 
a  good  nurse  never  fails  to  anticipate  all,  or 
nearly  all,  the  more  important  wants  of  the 
sufferer. 

Among  the  things  to  be  specially  attended 
to  in  nursing  is  ventilation.  Persons  visiting 
the  sick  must  at  once  be  struck  with  the  dif- 
ference of  pure  air  in  those  chambers  where 
a  proper  ventilation  exists  and  those  where 
the  reverse  is  the  case.  To  insure  this  the 
fresh  air  should  always  be  admitted  from  a 
window  not  open  directly  on  the  bed,  or 
causing  the  patient  to  be  in  a  draught.  Even 
in  winter  it  is  highly  proper  that  fresh  air 
should  be  admitted  some  time  during  the  day 
when  there  is  a  good  fire  and  the  patient  well 
protected  by  covering. 

The  pillows,  bedding,  and  bedclothes  should 
be  well  aired  and  often  changed,  as  also  the 
flannel,  under-garments,  and  night-dress.  To 
facilitate  this,  it  is  well,  when  the  patient  is 
•very  ill  and  unable  to  help  himself,  to  have 
the  shirt  open  all  the  way  down  in  front,  and 
buttoned  up.  The  patient  often  escapes  great 


42  A   MANUAL   OF 

suffering  and  annoyance  by  this  simple  method. 
Where  there  is  a  discharge  from  sores  or  when 
water-dressings  aje  applied  to  a  limb,  it  is  ad- 
visable to  place  the  latter  upon  a  folded  sheet 
with  a  thin,  soft  oil-cloth  underneath.  Great 
tenderness  and  cleanliness  should  be  used  in 
dressing  wounds  or  sores.  Old  linen,  muslin, 
and  lint  should  always  be  had  in  readiness  for 
this  purpose.  A  great  prejudice  exists  against 
the  use  of  muslin,  the  preference  being  gener- 
ally given  to  linen,  but  the  former  is  really 
quite  as  good  as  the  other,  if  it  is  soft  and  old. 
In  regard  to  the  cleanliness  of  a  sick-room, 
it  is  advisable  to  use  a  mop  occasionally  for 
the  removal  of  flue  from  under  the  bed ;  when, 
however,  the  patient  is  in  too  critical  a  situa- 
tion for  dampness,  a  few  tea-leaves  scattered 
over  the  apartment  will  absorb  the  dust,  and 
can  be  quietly  taken  up  with  a  hand-brush. 
A  frequent  change  of  bed  linen  is  very  bene- 
ficial when  practicable,  and  the  clothes  must 
always  be  folded  smoothly  under  the  patient. 
Great  cleanliness  should  be  observed  in  all 
the  surroundings  of  the  sick-room,  and  par- 
ticular attention  must  be  paid  to  the  glasses 
in  which  medicine  is  given,  in  order  to  render 


MILITARY    SURGERY.  43 

the  doses  as  palatable  as  possible.  The  patient 
should  be  washed  whenever  able,  and  his 
teeth  and  hair  well  attended  to.  The  body 
seems  infused  with  new  vigor  after  such  ablu- 
tions. 

A  frequent  change  of  posture  is  immensely 
conducive  to  the  comfort  and  well-being  of  a 
sick  person,  if  performed  with  a  careful  eye 
to  his  particular  condition.  Severe  pain,  loss 
of  sleep,  excessive  constitutional  irritation, 
and  dreadful  bed-sores  are  sure  to  follow,  in 
all  low  states  of  the  system,  if  this  precaution 
be  not  duly  heeded.  No  patient  must  have 
his  head  suddenly  raised,  or  be  permitted  to 
lie  high,  when  he  is  exhausted  from  shock, 
hemorrhage,  or  sickness.  Many  lives  have 
been  lost  by  this  indiscretion. 

The  apartment  must  be  free  from  noise, 
the  light  should  neither  be  too  freely  admitted 
nor  too  much  excluded,  except  in  head  and 
eye  affections,  and  the  temperature  must  be 
regulated  by  the  thermometer,  from  65°  to 
68°  of  Fahrenheit  being  a  proper  average. 

As  the  patient  acquires  strength,  he  may 
gradually  sit  up  in  bed,  propped  up  at  first 
by  pillows,  and  afterward  by  a  bed-chair. 


44  A   MANUAL  OF 

His  food  and  drink,  and  also,  at  times,  his 
medicine,  must  be  given  from  a  feeding-cup 
during  the  height  of  his  disease,  and  a  good 
general  rule  is  to  administer  them  with  great 
regularity,  provided  this  does  not  interfere 
too  much  with  his  repose.  If  he  is  very  weak, 
and  sleeps  very  long,  it  will  be  necessary  to 
wake  him  in  order  to  give  him  nourishment ; 
but,  in  general,  sleep  is  more  refreshing  than 
food,  and  more  beneficial  than  medicine.  The 
bed-pan  and  urinal  of  course  find  their  appro- 
priate sphere  under  such  circumstances. 

As  the  appetite  and  strength  increase,  the 
patient  is  permitted  to  resume,  though  very 
gradually,  his  accustomed  diet,  and  to  exercise 
about  the  room,  if  not  in  the  open  air.  After 
severe  accidents  and  protracted  sickness,  a 
wise  man  will  not  bestir  himself  too  soon  or 
too  much,  but  court  the  fickle  goddess  of 
health  with  becoming  caution. 

Dying  patients  should  be  carefully  screened 
from  their  neighbors,  placed  in  the  easiest 
posture,  have  free  access  of  air,  and  be  not 
disturbed  by  noise,  loud  talking,  or  the  pres- 
ence of  persons  not  needed  for  their  comfort. 
As  soon  as  the  mortal  struggle  is  over,  the 
body  must  be  removed. 


MILITARY   SURGERY.  45 

The  excretions  should  be  removed  as  speed- 
ily as  possible  from  the  apartment,  and  the 
vessels  in  which  they  are  received  immediately 
well  scalded,  the  air  being  at  the  same  time 
perfectly  purified  by  ventilation,  or  ventila- 
tion and  disinfectants. 

Finally,  the  nurse  must  take  care  of  her- 
self. She  must  have  rest,  or  she  will  soon 
break  down.  If  she  is  obliged  to  be  up  all 
night,  she  should  be  spared  in  the  day. 


CHAPTER  V. 
Wounds  and  Other  Injuries. 

THE  injuries  inflicted  in  war  are,  in  every 
respect,  similar  to  those  received  in  civil  life. 
The  most  common  and  important  are  frac- 
tures, dislocations,  bruises,  sprains,  burns, 
and  the  different  kinds  of  wounds,  as  the 
incised,  punctured,  lacerated,  and  gunshot. 
With  the  nature,  diagnosis,  and  mode  of 
treatment  of  these  lesions  every  army  sur- 
geon must,  of  course,  be  supposed  to  be 
familiar ;  and  I  shall  therefore  limit  myself, 
5 


46  A   MANUAL   OF 

in  the  remarks  which  I  am  about  to  offer 
upon  these  subjects,  to  a  few  practical  hints 
respecting  their  management  on  the  field  of 
battle  and  in  the  ambulance. 

Most  of  the  cases  of  fractures  occurring  on 
the  field  of  battle  are  the  result  of  gunshot 
injury,  and  are  frequently,  if  not  generally, 
attended  by  such  an  amount  of  injury  to  the 
soft  parts  and  also  to  the  bone  as  to  demand 
amputation.  The  bone  is  often  dreadfully 
comminuted,  and  consequently  utterly  unfit 
for  preservation.  The  more  simple  fractures, 
on  the  contrary,  readily  admit  of  the  reten- 
tion of  the  limb,  without  risk  to  life. 

In  transporting  persons  affected  with  frac- 
tures, whether  simple  or  complicated,  the 
utmost  care  should  be  used  to  render  them 
as  comfortable  as  possible,  by  placing  the  in- 
jured limb  in  an  easy  position,  and  applying, 
if  need  be,  on  account  of  the  distance  to 
which  they  have  to  be  carried,  or  the  mode 
of  conveyance,  short  side  splints  of  binders' 
board,  thin  wood,  as  a  shingle,  or  junks  of 
straw,  gently  confined  by  a  roller.  For  want 
of  due  precaution  the  danger  to  limb  and 
life  may  be  materially  augmented.  Perma- 


MILITARY    SURGERY.  47 

nent  dressings  should  be  applied  at  the  ear- 
liest moment  after  the  patient  reaches  the 
hospital.  If  the  fracture  be  attended  with 
splintering  of  the  bone,  all  loose  or  detached 
pieces  should  at  once  be  extracted;  a  pro- 
ceeding which  always  wonderfully  simplifies 
the  case,  inasmuch  as  it  prevents,  in  great 
measure,  the  frightful  irritation  and  suppura- 
tion which  are  sure  to  follow  their  retention. 
When  this  point  has  been  properly  attended 
to,  the  parts  should  be  neatly  brought  to- 
gether by  suture,  and  covered  with  a  com- 
press wet  with  blood.  As  soon  as  inflamma- 
tion arises — not  before — water-dressings  are 
employed.  A  suitable  opening,  or  bracket, 
should  be  made  in  the  apparatus  to  facilitate 
drainage  and  dressing. 

Dislocations,  accidents  by  no  means  com- 
mon in  military  operations,  are  treated  ac- 
cording to  the  general  rules  of  practice;  they 
should  be  speedily  reduced,  without  the  aid 
of  chloroform,  if  the  patient  is  faint  or  ex- 
hausted; with  chloroform,  if  he  is  strong  or 
reaction  has  been  fully  established.  The 
operation  may  generally  be  successfully  per- 
formed by  simple  manipulation;  if,  however. 


48  A   MANUAL   OF 

the  case  is  obstinate,  pulleys  may  be  neces- 
sary, or  extension  and  counter-extension 
made  by  judicious  assistants. 

Bruises,  or  contusions,  unless  attended  with 
purification,  disorganization,  or  destruction 
of  the  tissues,  are  best  treated,  at  first,  until 
the  pain  subsides,  with  tepid  water  impreg- 
nated with  laudanum  and  sugar  of  lead,  or 
some  tepid  spirituous  lotion,  and  afterward, 
especially  if  the  patient  be  strong  and  robust, 
with  cold  water,  or  cold  astringent  fluids. 
If  the  injury  be  deep  seated,  extensive,  and 
attended  with  lesion  of  very  important  struc- 
tures, the  case  will  be  a  serious  one,  liable  to 
be  followed  by  the  worst  consequences,  re- 
quiring, perhaps,  amputation. 

Sprains  are  often  accompanied  with  exces- 
sive pain  and  even  severe  constitutional  symp- 
toms. They  should  be  treated  with  the  free 
use  of  anodynes  and  with  warm  water-dress- 
ings medicated  with  laudanum,  or  laudanum 
and  lead.  The  joint  must  be  elevated  and 
kept  at  rest  in  an  easy  position.  Leeches 
may  be  applied,  if  they  can  be  obtained; 
otherwise,  if  plethora  exist,  blood  may  be 
taken  from  the  arm.  By-and-by  sorbefacient 


MILITARY    SURGERY.  49 

liniments  and  friction  come  in  play.  Passive 
motion  should  not  be  instituted  too  soon. 

Among  the  accidents  of  war  are  burns,  and, 
occasionally,  also  scalds.  The  former  may  be 
produced  by  ordinary  fire  or  by  the  explosion 
of  gunpowder,  either  casual  or  from  the  blow- 
ing up  of  redoubts,  bridges,  houses  or  arsenals, 
and  vary  from  the  most  trivial  to  the  most 
serious  lesions,  involving  a  great  extent  of 
surface  or  of  tissue,  and  liable  to  be  followed 
by  the  worst  consequences.  Such  injuries 
always  require  prompt  attention;  for,  apart 
from  the  excessive  pain  and  collapse  which  so 
often  accompany  them,  the  longer  they  re- 
main uncared  for  the  more  likely  will  they 
be  to  end  badly. 

Various  remedies  have  been  proposed  for 
these  injuries.  I  have  myself  always  found 
white-lead  paint,  such  as  that  employed  in 
the  arts,  mixed  with  linseed  oil  to  the  consist- 
ence of  very  thick  cream,  and  applied  so  as 
to  form  a  complete  coating,  the  most  soothing 
and  efficient  means.  The  dressing  is  finished 
by  enveloping  the  parts  in  wadding,  confined 
by  a  moderately  tight  roller.  It  should  not 
be  removed,  unless  there  is  much  discharge  or 
5* 


50  A  MANUAL   OF 

swelling,  for  several  days.  If  vesicles  exist, 
they  should  previously  be  opened  with  a 
needle  or  the  point  of  a  bistoury.  A  lini- 
ment or  ointment  of  glycerin,  lard  or  simple 
cerate,  and  subnitrate  of  bismuth,  as  sug- 
gested by  my  friend,  Professor  T.  G.  Rich- 
ardson, of  New  Orleans,  is  also  an  excellent 
remedy,  and  may  be  used  in  the  same  manner 
as  the  white-lead  paint.  In  the  milder  cases, 
carded  cotton,  cold  water,  water  and  alcohol, 
water  and  laudanum,  or  solutions  of  lead  and 
laudanum,  generally  aiford  prompt  relief. 
Amputation  will  be  necessary  when  there  is 
extensive  destruction  of  the  muscles,  bones, 
or  joints.  Reaction  must  be  promoted  by 
the  cautious  use  of  stimulants ;  while  pain  is 
allayed  by  morphia  or  laudanum  given  with 
more  than  ordinary  circumspection,  lest  it 
induce  fatal  oppression  of  the  brain. 

In  burns  from  the  explosion  of  gunpowder , 
particles  of  this  substance  are  often  buried  in 
the  skin,  where,  if  it  be  not  removed,  they 
leave  disfiguring  marks.  The  best  way  to  get 
rid  of  them  is  to  pick  out  grain  after  grain 
with  the  point  of  a  narrow-bladed  bistoury  or 
cataract  needle. 


MILITARY   SURGERY.  51 

Tl^e  subject  of  wounds  is  a  most  important 
one  in  regard  to  field  practice,  as  these  lesions 
are  not  only  of  frequent  occurrence,  but  pre- 
sent themselves  in  every  variety  of  form  and 
extent.  Their  gravity  is  influenced  by  numer- 
ous circumstances  which  our  space  does  not 
permit  us  to  specify,  but  which  the  intelligent 
reader  can  readily  appreciate.  In  many  cases 
death  is  instantaneous,  owing  to  shock,  or 
shock  and  hemorrhage;  in  others  it  occurs 
gradually,  with  or  without  reaction,  at  a  period 
of  several  hours,  or,  it  may  be,  not  under  sev- 
eral days.  Sometimes  men  are  destroyed  by 
shock,  by,  apparently,  the  most  insignificant 
wound  or  injury,  owing,  not  to  want  of  cour- 
age, but  to  some  idiosyncrasy. 

The  indications  presented  in  all  wounds,  of 
whatever  nature,  are — 1st,  to  relieve  shock; 
2dly,  to  arrest  hemorrhage;  3dly,  to  remove 
foreign  matter;  4thly,  to  approximate  and 
retain  the  parts;  and,  5thly,  to  limit  the 
resulting  inflammation. 

1.  It  is  not  necessary  to  describe  minutely 
the  symptoms  of  shock,  as  the  nature  of  the 
case  is  sufficiently  obvious  at  first  sight,  from 
the  excessive  pallor  of  the  countenance,  the 


. 

52  A  MANUAL   OF 

weakened  or  absent  pulse,  the  confused.state 
of  the  mind,  the  nausea,  or  nausea  and  vomit- 
ing, and  the  excessive  bodily  prostration.  The 
case  must  be  treated  promptly:  by  free  ac- 
cess of  fresh  air  and  the  use  of  the  fan,  by 
loosening  the  dress  or  the  removal  of  all  sources 
of  constriction,  by  dashing  cold  water  into 
the  face  and  upon  the  chest,  by  recumbency 
of  the  head,  and  by  a  draught  of  cold  water, 
or  water  and  spirits,  wine  or  hartshorn,  if  the 
patient  can  swallow;  aided,  if  the  case  be  ur- 
gent, by  sinapisms  to  the  region  of  the  heart, 
the  inside  of  the  thighs  and  the  spine,  and 
stimulating  injections,  as  brandy,  turpentine, 
mustard,  or  ammonia,  in  a  few  ounces  of 
water.  No  fluid  must  be  put  into  the  mouth 
so  long  as  the  power  of  deglutition  is  gone, 
lest  some  of  it  should  enter  the  windpipe,  and 
so  occasion  suffocation.  Whatever  the  cause  of 
the  shock  may  have  been,  let  the  medical 
attendant  not  fail  to  encourage  the  sufferer  by 
a  kind  and  soothing  expression,  which  is  often 
of  more  value  in  recalling  animation  than  the 
best  cordials. 

During  an  actual  engagement,  the  medical 
officers,  as  well  as  their  servants,  should  carry 


MILITARY   SURGERY.  53 

in  their  pockets  such  articles  as  the  wounded 
will  be  most  likely  to  need  on  the  field  of  bat- 
tle, as  brandy,  aromatic  spirits  of  hartshorn, 
and  morphia,  put  up  in  suitable  doses. 

2.  The  hemorrhage  may  be  arterial  or  ve- 
nous, or  both  arterial  and  venous,  slight  or 
profuse,  primary  or  secondary,  external  or 
internal.  The  scarlet  color  and  saltatory  jet 
will  inform  us  when  it  is  arterial;  the  purple 
hue  and  steady  flow,  when  it  is  venous. 
When  the  wound  is  severe,  or  involving  a 
large  artery  or  vein,  or  even  middle-sized 
vessels,  the  bleeding  may  prove  fatal  in  a  few 
minutes,  unless  immediate  assistance  is  ren- 
dered. Hundreds  of  persons  die  on  the  field 
of  battle  from  this  cause.  They  allow  their 
life-current  to  run  out,  as  water  pours  from 
a  hydrant,  without  an  attempt  to  stop  it  by 
thrusting  the  finger  in  the  wound,  or  com- 
pressing the  main  artery  of  the  injured  limb. 
They  perish  simply  from  their  ignorance, 
because  the  regimental  surgeon  has  failed  to 
give  the  proper  instruction.  It  is  not  neces- 
sary that  the  common  soldier  should  carry  a 
Petit's  tourniquet,  but  every  one  may  put 
into  his  pocket  a  stick  of  wood,  six  inches 


54  A  MANUAL  OF 

long,  and  a  handkerchief  or  piece  of  roller, 
with  a  thick  compress,  and  be  advised  how, 
where,  and  when  they  are  to  be  used.  By 
casting  the  handkerchief  round  the  limb,  and 
placing  the  compress  over  its  main  artery,  he 
can,  by  means  of  the  stick,  produce  such  an 
amount  of  compression  as  to  put  at  once  an 
effectual  stop  to  the  hemorrhage.  This  simple 
contrivance,  which  has  been  instrumental  in 
saving  thousands  of  lives,  constitutes  what  is 
called  the  field  tourniquet.  A  fife,  drum-stick, 
knife,  or  ramrod  may  be  used,  if  no  special 
piece  of  wood  is  at  hand. 

The  most  reliable  means  for  arresting  hem- 
orrhage permanently  is  the  ligature,  of  strong, 
delicate,  well-waxed  silk,  well  applied,  with 
one  end  cut  off  close  to  the  knot.  Acupres- 
sure is  hardly  a  proper  expedient  upon  the 
battle-field,  or  in  the  ambulance,  especially 
when  the  number  of  wounded  is  considerable. 
The  rule  invariably  is  to  tie  a  wounded  artery 
both  above  and  below  the  seat  of  injury,  lest 
recurrent  bleeding  should  arise.  Another 
equally  obligatory  precept  is  to  ligature  the 
vessel,  if  practicable,  at  the  place  whence  the 
blood  issues,  by  enlarging,  if  need  be,  the 


MILITARY    SURGERY.  55 

original  wound.  The  main  trunk  of  the  ar- 
tery should  be  secured  only  when  it  cannot  be 
taken  up  at  the  point  just  mentioned.  Lastly, 
it  is  hardly  requisite  to  add  that  the  operation 
should  be  performed,  with  the  aid  of  the  tour- 
niquet, as  early  as  possible,  before  the  super- 
vention of  inflammation  and  swelling,  which 
must  necessarily  obscure  the  parts  and  in- 
crease the  surgeon's  embarrassment,  as  well 
as  the  patient's  pain  and  risk. 

Venous  hemorrhage  usually  stops  sponta- 
neously, or  readily  yields  to  compression, 
even  when  a  large  vein  is  implicated.  The 
ligature  should  be  employed  only  in  the  event 
of  absolute  necessity,  for  fear  of  inducing  un- 
due inflammation. 

Torsion  is  unworthy  of  confidence  in  field 
practice,  and  the  same  is  true  of  styptics,  except 
when  the  hemorrhage  is  capillary,  or  the  blood 
oozes  from  numerous  points.  The  most 
approved  articles  of  this  kind  are  Monsel's 
salt,  or  the  persulphate  of  iron  and  the  per- 
chloride  of  iron;  the  latter  deserving  the 
preference,  on  account  of  the  superiority  of 
its  hemostatic  properties.  Alum  and  lead  are 
inferior  styptics. 


56  A  MANUAL   OF 

Temporary  compression  may  be  made  with 
the  tourniquet,  or  a  compress  and  a  roller.  It 
may  be  direct,  as  when  the  compress  is  applied 
to  the  orifice  of  the  bleeding  vessel,  or  indi- 
rect, as  when  it  is  applied  to  the  trunk  of  the 
vessel,  at  some  distance  from  the  wound. 

Constitutional  treatment  in  hemorrhage  is 
of  paramount  importance.  It  comprises 
perfect  tranquillity  of  mind  and  body,  cool- 
ing drinks,  a  mild,  concentrated,  nourish- 
ing diet,  especially  when  there  has  been  ex- 
cessive loss  of  blood,  anodynes  to  allay  pain, 
induce  sleep,  and  allay  the  heart's  inordinate 
action,  fresh  air,  and  a  properly  regulated 
light. 

Internal  hemorrhage  is  more  dangerous 
than  external,  because  it  is  generally  inac- 
cessible. The  chief  remedies  are  copious 
venesection,  elevated  position,  opium  and 
acetate  of  lead,  cool  air  and  cool  drinks. 

Exhaustion  from  hemorrhage  should  be 
treated  according  to  the  principles  which 
guide  the  practitioner  in  cases  of  severe 
shock.  Opium  should  be  given  freely  as  soon 
as  reaction  begins  to  quiet  the  tremulous 
movements  of  the  heart  and  tranquilize  the 


MILITARY   SURGERY.  57 

mind.  When  the  bleeding  is  internal,  the 
reaction  should  be  brought  about  gradually, 
not  hurriedly,  lest  we  thus  become  instrumental 
in  promoting  or  re-exciting  the  hemorrhage. 

Secondary  hemorrhage  comes  on  at  a 
variable  period,  from  a  few  hours  to  a  num- 
ber of  days ;  it  may  depend  upon  imperfect 
ligation  of  the  arteries,  ulceration,  softening 
or  gangrene  of  the  coats  of  these  vessels,  or 
upon  undue  constriction  of  the  tissues  by  tight 
bandages.  In  some  cases  it  is  venous,  and 
may  then  be  owing  to  inadequate  support  of  the 
parts.  Whatever  the  cause  may  be,  it  should 
be  promptly  searched  out,  and  removed. 

3.  The  third  indication  is  to  remove  all 
foreign  matter.    This  should  be  done  at  once 
and    effectually;    with    sponge    and    water, 
pressed  upon  the  parts,  with  finger,  or  finger 
and  forceps.    Not  a  particle  of  matter,  not  a 
hair,  or  the  smallest  clot  of  blood  must  be 
left  behind,  otherwise  it  will  be  sure  to  pro- 
voke and  keep  up  irritation. 

4.  As  soon  as  the  bleeding  has  been  checked 
and  the  extraneous  matter  cleared  away,  the 
edges  of  the  wound  are  gently  and  evenly 

6 


58  A    MANUAL   OF 

approximated,  and  permanently  retained  by 
suture  and  adhesive  plaster,  aided,  if  neces- 
sary, by  the  bandage.  The  best  suture, 
because  the  least  irritating,  is  that  made 
of  silver  wire ;  but  if  this  material  is  not 
at  hand,  strong,  thin,  well-waxed  silk  is 
used.  The  adhesive  strips  are  applied  in 
such  a  manner  as  to  admit  of  free  drainage. 
The  bandage  is  required  chiefly  in  injuries 
extending  deeply  among  the  muscles;  when 
this  is  the  case,  its  use  should  be  aided  by 
compresses  arranged  so  as  to  force  together 
the  deep  parts  of  the  wound. 

5.  When  the  wound  is  dressed,  the  next 
duty  of  the  surgeon  is  to  moderate  the  re- 
sulting inflammation.  For  this  purpose  the 
ordinary  antiphlogistic  means  are  employed. 
In  genera],  very  little  medicine  will  be  re- 
quired, except  a  full  anodyne,  as  half  a  grain 
of  morphia,  immediately  after  the  patient 
has  sufficiently  recovered  from  the  effects  of 
his  shock,  and  perhaps  a  mild  aperient  the 
ensuing  morning,  especially  if  there  be  con- 
stipation with  a  tendency  to  excessive  reac- 
tion. The  drinks  must  be  cooling,  and  the 
diet  light  and  nutritious,  or  otherwise,  accord- 


MILITARY   SURGERY.  59 

ing  to  the  amount  of  depression  and  loss  of 
blood.  In  the  latter  event,  a  rich  diet  and 
milk-punch  may  be  required  from  the  begin- 
ning. A  diaphoretic  draught  will  be  needed 
if  the  skin  is  hot  and  arid,  aided  by  frequent 
sponging  of  the  surface  with  cool  or  tepid 
water.  General  bleeding  will  rarely,  if  ever, 
be  required;  certa&ily  not  if  the  injury  is  at 
all  severe,  or  if  there  has  already  been  any 
considerable  waste  of  blood  and  nervous 
fluid. 

Much  trouble  is,  at  times,  experienced  both 
in  civil  and  military  practice,  especially  in 
very  hot  weather,  in  preventing  the  access  of 
flies  to  our  dressing.  The  larvae  which  they 
deposit  are  rapidly  developed  into  immense 
maggots,  which,  creeping  over  the  wounds 
and  sores  of  the  patient,  and  gnawing  the 
parts,  cause  the  most  horrible  distress.  The 
soldiers  in  Syria,  under  Larrey,  were  greatly 
annoyed  by  these  insects,  and  our  wounded  in 
Mexico  also  suffered  not  a  little  from  them. 
The  best  prevention  is  bran,  or  light  saw-dust, 
with  which  the  injured  parts  should  be  care- 
fully covered.  The  use  of  cotton  must  be 
avoided,  inasmuch  as  it  soon  becomes  hot  and 


60  A   MANUAL    OF 

wet — two  circumstances  highly  favorable  to 
incubation. 

The  best  local  applications  are  the  water- 
dressings,  either  tepid,  cool,  or  cold,  accord- 
ing to  the  temperament  of  the  patient,  the 
tolerance  of  the  parts,  and  the  season  of  the 
year.  Union  by  the  first  intention  is,  in  all 
the  more  simple  cases,  the  thing  aimed  at 
and  steadily  kept  in  view,  and  hence  the  less 
the  parts  are  encumbered,  moved  or  fretted, 
the  more  likely  shall  we  be  to  attain  the 
object. 

The  medical  attendant  should  have  a  con- 
stant eye  to  the  condition  of  the  bladder  after 
all  severe  injuries,  of  whatever  character,  as 
retention  of  urine  is  an  extremely  common 
occurrence,  and  should  always  be  promptly 
remedied.  Attention  to  this  point  is  the 
more  necessary,  because  the  poor  patient,  in 
his  comatose  or  insensible  condition,  is  fre- 
quently unable  to  make  known  his  wants. 

Such,  in  a  few  words,  are  the  general  prin- 
ciples of  treatment  to  be  followed  in  all 
wounds;  but  there  are  some  wounds  which 
are  characterized  by  peculiarities,  and  these 
peculiarities  are  of  such  practical  importance 


MILITARY    SURGERY.  61 

as  to  require  separate  consideration.  Of  this 
nature  are  punctured,  lacerated,  and  gunshot 
wounds. 

Punctured  wounds  are  inflicted  by  various 
kinds  of  weapons,  as  the  lance,  sabre,  sword, 
or  bayonet.  In  civil  practice  they  are  most 
generally  met  with  as  the  result  of  injuries 
inflicted  by  nails,  needles,  splinters,  and  frag- 
ments of  bone.  They  often  extend  into  the 
visceral  cavities,  joints,  vessels,  and  nerves ; 
and  are  liable  to  be  followed  by  excessive 
pain,  erysipelas,  and  tetanus ;  seldom  heal  by 
adhesive  action ;  and  often  cause  death  by 
shock  or  hemorrhage.  When  the  vulnerating 
body  is  broken  off  and  buried,  it  may  be  diffi- 
cult to  find  and  extract  it,  especially  when 
small  and  deep  seated.  When  this  is  the 
case,  the  wound  must  be  freely  dilated,  an  eye 
being  had  to  the  situation  of  the  more  im- 
portant vessels  and  nerves.  In  other  respects, 
the  general  principles  of  treatment  are  similar 
to  those  of  incised  wounds.  Opium  should 
be  administered  largely;  and,  if  much  ten- 
sion supervene,  or  matter  form,  free  incisions 
will  be  necessary. 

In  lacerated  wounds  the  edges  should  be 
6* 


62  A   MANUAL    OF 

tacked  together  very  gently,  and  large  inter- 
spaces left  for  drainage.  A  small  portion 
will  probably  unite  by  the  first  intention; 
the  remainder,  by  the  granulating  process. 
Such  wounds  nearly  always  suppurate  more 
or  less  profusely,  and  some  of  the  torn  and 
bruised  tissues  not  unfrequently  perish.  The 
same  bad  consequences  are  apt  to  follow  them 
as  in  punctured  wounds.  Warm  water  con- 
stitutes the  best  dressing,  either  alone  or  with 
the  addition  of  a  little  spirits  of  camphor. 
Opium  should  be  used  freely  internally,  and 
the  diet  must  be  supporting. 

G-unshot  wounds,  in  their  general  character, 
partake  of  the  nature  of  lacerated  and  con- 
tused wounds.  They  are,  of  course,  the  most 
common  and  dangerous  lesions  met  with  in 
military  practice ;  often  killing  instantly,  or, 
at  all  events,  so  mutilating  the  patient  as  to 
destroy  him  within  a  few  hours  or  days  after 
their  receipt.  The  most  formidable  wounds 
of  the  kind  are  made  by  the  conical  rifle  and 
musket  balls  and  by  cannon  balls,  the  latter 
often  carrying  away  the  greater  portion  of  a 
limb,  or  mashing  and  pulpifying  the  muscles 
and  viscera  in  the  most  frightful  and  destruc- 


MILITARY    SURGERY.  63 

tive  manner;  while  the  former  commit  terrible 
ravages  among  the  bones,  breaking  them  into 
numerous  fragments,  each  of  which  may,  in 
its  turn,  tear  up  the  soft  tissues  in  a  way 
perhaps  not  less  mischievous  than  the  ball 
itself.  The  old  round  ball  is  a  much  less 
fatal  weapon  than  the  conical,  which  seldom 
becomes  flattened,  and  which  has  been  known 
to  pass  through  the  bodies  of  two  men  and 
lodge  in  that  of  a  third  some  distance  off. 

When  a  ball  lodges  it  makes  generally  only 
one  orifice ;  but  it  should  be  remembered  that 
it  may  make  two,  three,  and  even  four,  and 
at  last  bury  itself  more  or  less  deeply.  Such 
cases  are,  however,  uncommon.  Should  the 
missile  escape,  there  will  necessarily  be  two 
openings ;  or,  if  it  meet  a  sharp  bone  and  be 
thereby  divided  or  cut  in  pieces,  as  sometimes 
happens,  there  may  be  even  three.  The  orifice 
of  entrance  and  the  orifice  of  exit  differ  in  their 
appearances.  The  first  is  small,  round,  and 
often  a  little  discolored  from  the  explosion  of 
the  powder;  the  other,  on  the  contrary,  is 
comparatively  large,  slit-like,  everted,  and 
free  from  color.  These  differences,  however, 
are  frequently  very  trifling,  particularly  if  the 


64  A  MANUAL    OF 

ball  be  projected  with  great  velocity  and  it 
do  not  encounter  any  bone.  The  opening 
of  entrance  made  by  the  round  ball  is  often 
a  little  depressed  or  inverted,  but  such  an  ap- 
pearance is  extremely  uncommon  in  wounds 
made  by  the  conical  ball. 

It  is  often  a  matter  of  great  importance  to 
determine,  when  two  openings  exist  in  a  limb, 
whether  they  have  been  made  by  one  ball, 
which  has  passed  out,  or  by  two  balls,  which 
are  retained.  The  question  is  of  grave  im- 
portance, both  in  a  practical  and  in  a  medico- 
legal  point  of  view ;  but  its  solution  is,  unfor- 
tunately, not  always  possible.  Sometimes 
the  openings  of  entrance  and  exit  are  materi- 
ally modified  by  the  introduction  but  non- 
escape  of  a  foreign  body,  as  a  piece  of  breast- 
plate, belt,  or  buckle,  along  with  the  ball, 
which  alone  passes  out,  or  by  the  flattening 
of  a  ball  against  a  bone,  or  its  division  by  a 
bone  into  several  fragments,  each  of  which 
may  afterward  produce  a  separate  orifice. 
Generally  speaking,  the  missile,  at  the  place 
of  entrance,  carries  away  a  piece  of  skin, 
and  rends  the  skin  where  it  escapes,  the  for- 
mer being  often  found  in  the  wound. 


MILITARY    SURGERY.  65 

Bullets  sometimes  glance,  bruising  the  skin, 
but  not  penetrating  it;  at  other  times  they 
effect  an  entrance,  but,  instead  of  passing  on 
in  a  straight  line,  are  deflected,  coursing,  per- 
haps, partially  round  the  head,  chest,  or  ab- 
domen, or  round  a  limb.  Such  results  are 
most  commonly  caused  by  a  partially  spent 
bullet  coming  in  contact  with  bones,  aponeu- 
roses,  and  tendons ;  arid  the  round  is  more 
frequently  served  in  this  way  than  the  conical. 

Gunshot  wounds  bleed  profusely  only  when 
a  tolerably  large  artery  has  been  injured, 
and  in  this  event  they  may  speedily  prove 
fatal.  During  the  Crimean  war,  however, 
many  cases  occurred  in  which  there  was  no 
immediate  hemorrhage,  imperiling  life,  not- 
withstanding the  limbs,  lower  as  well  as  upper, 
were  left  hanging  merely  by  the  integuments. 
Under  such  circumstances,  intermediary  hem- 
orrhage, as  it  is  termed,  is  apt  to  show  itself  as 
soon  as  reaction  takes  place — generally  within 
a  few  hours  after  the  accident. 

The  pain  is  of  a  dull,  burning,  smarting, 
or  aching  character,  and  the  patient  is  pale, 
weak,  tremulous,  nauseated,  and  despondent, 
often  in  a  degree  far  beyond  what  might  be 


66  A   MANUAL    OF 

expected  from  the  apparent  violence  of  the 
injury,  and  that,  too,  perhaps,  when  the  indi- 
vidual is  of  the  most  undaunted  courage  and 
self-possession  in  the  heat  of  battle.  At  other 
times  a  man  may  have  a  limb  torn  off,  or  be 
injured  in  some  vital  organ,  and  yet  hardly 
experience  any  shock  whatever ;  nay,  perhaps 
be  scarcely  conscious  that  he  is  seriously  hurt. 
The  pain  and  prostration  are  always  greater, 
other  things  being  equal,  when  a  bone  has 
been  crushed  or  a  large  joint  laid  open,  than 
when  there  is  a  mere  flesh  wound. 

The  gravity  of  gunshot  wounds  of  the  joints 
has  been  recognized  by  all  practitioners,  both 
military  and  civil,  from  time  immemorial.  The 
principal  circumstances  of  the  prognosis  are 
the  size  and  complexity  of  the  articulation, 
the  extent  of  the  injury,  and  the  state  of  the 
system.  A  gunshot  wound  of  a  ginglymoid 
joint  is,  in  general,  a  more  dangerous  affair  than 
a  similar  one  of  a  ball-and-socket  joint.  The 
structures  around  the  articulation  often  suffer 
severely,  thus  adding  greatly  to  the  risk  of 
limb  and  life.  Of  65  cases  of  gunshot  wounds 
of  different  joints,  related  by  Alcock,  33  re- 
covered; but  of  these  21  lost  the  limb.  Of 


MILITARY    SURGERY.  67 

the  32  that  died  no  operation  was  performed 
upon  18. 

Gunshot  wounds  of  the  smaller  joints, 
even  those  of  the  ankle,  often  do  very 
well,  although  they  always  require  long  and 
careful  treatment.  Lesions  of  this  kind,  in- 
volving the  shoulder,  are  frequently  amenable 
to  ordinary  means.  If  the  ball  lodges  in  the 
head  of  the  huinerus,  it  must  be  extracted 
without  delay,  its  retention  being  sure  to 
excite  violent  inflammation  in  the  soft  parts, 
and  caries  or  necrosis  in  the  bone,  ultimately 
necessitating  amputation,  if  not  causing  death. 

Gunshot  wounds  of  the  knee-joint  are  among 
the  most  dangerous  of  accidents,  and  no 
attempt  should  be  made  to  save  the  limb  when 
the  injury  is  at  all  extensive,  especially  if  it 
involves  fracture  of  the  head  of  the  tibia  or 
condyles  of  the  femur.  Even  extensive  lacer- 
ation of  the  ligament  of  the  patella  should,  I 
think,  as  a  general  rule,  be  regarded  as  a  suf- 
ficient cause  of  amputation.  In  1854,  Macleod 
saw  upwards  of  forty  cases  of  gunshot  wounds 
of  the  knee  in  the  French  hospitals  in  the 
Crimea,  and  all,  except  one,  in  which  an  at- 
tempt was  made  to  save  the  limb,  proved 


68  A    MANUAL    OF 

/ 

fatal.  Of  nine  cases  which  occurred  in  India 
not  one  was  saved.  Guthrie  never  saw  a 
patient  recover  from  a  gunshot  wound  of  the 
knee-joint;  and  Esmarch,  who  served  in  the 
Schleswig-Holstein  wars,  expressly  declares 
that  all  lesions  of  this  kind  demand  immediate 
amputation  of  the  thigh. 

When,  in  bad  cases  of  these  articular  inju- 
ries, an  attempt  is  made  to  save  the  limb,  the 
patient  often  perishes  within  the  first  three  or 
four  days,  from  the  conjoined  effects  of  shock, 
hemorrhage,  and  traumatic  fever.  If  he  sur- 
vives for  any  length  of  time,  large  abscesses 
are  apt  to  form  in  and  around  the  joint,  the 
matter  burrowing  extensively  among  the  mus- 
cles, and  causing  detachment  of  the  perios- 
teum with  caries  and  necrosis  of  the  bones. 

Muscles,  badly  injured  by  bullets,  generally 
suppurate,  and  are  very  apt  to  become  perma- 
nently useless.  Special  pains  should  therefore 
be  taken  to  counteract  this  tendency  during 
the  cure.  Large  shot  and  other  foreign  bodies 
sometimes  lodge  among  these  structures,  where 
their  presence  may  remain  for  a  long  time 
unsuspected. 

Cannon  balls  often  do  immense  mischief 


MILITARY    SURGERY.  69 

by  striking  the  surface  of  the  body  obliquely, 
pulpifying  the  soft  structures,  crushing  the 
bones,  lacerating  the  large  vessels  and  nerves, 
and  tearing  open  the  joints,  without,  perhaps, 
materially  injuring  the  skin. 

A  very  terrible  form  of  contusion  is  often 
inflicted  upon  the  upper  extremity  of  artil- 
lerymen by  the  premature  explosion  of  the 
gun  while  in  the  act  of  loading;  causing  ex- 
cessive commotion  of  the  entire  limb,  lacera- 
tion of  the  soft  parts,  and  most  extensive 
infiltration  of  blood,  accompanied,  in  many 
cases,  by  comminuted  fracture,  and  penetra- 
tion of  the  wrist  and  elbow  joints.  The  con- 
stitutional shock  is  frequently  great.  If  an 
attempt  be  made  to  save  the  parts,  diffusive 
suppuration,  a*id  more  or  less  gangrene,  will 
be  sure  to  follow,  bringing  life  into  immi- 
nent jeopardy.  An  attempt  in  such  a  case 
to  save  the  limb  would  be  worse  than  useless, 
if,  indeed,  not  criminal ;  amputation  must  be 
promptly  performed,  and  that  at  a  consid- 
erable distance  above  the  apparent  seat  of 
the  injury,  otherwise  mortification  might  seize 
upon  the  stump. 

In  the  treatment  of  this  class  of  injuries, 
7 


70  A   MANUAL   OF 

the  first  thing  to  be  done,  after  arresting  the 
hemorrhage  and  relieving  shock,  is  to  extract 
the  ball  and  any  other  foreign  substance  that 
may  have  entered  along  with  it,  the  next  being 
to  guard  against  inflammation  and  other  bad 
consequences. 

In  order  to  ascertain  where  the  ball  is,  the 
limb  should  be  placed  as  nearly  as  possible  in 
the  position  it  was  supposed  to  have  been  at  the 
moment  of  the  accident.  A  long,  stout,  flex- 
ible, blunt-pointed  probe,  like  that  sketched 
in  the  annexed  cut,  or  a  straight  silver  cathe- 
ter, is  then  passed  along  the  track  and  gently 
moved  about  until  it  strikes  the  ball..  In 
many  cases  the  best  probe  is  the  surgeon's 
finger.  Valuable  information  may  often  be 
obtained  by  the  process  of  pinching,  or  digital 
compression,  the  ends  of  the  fingers  being 
firmly  and  regularly  pressed  against  the 
wounded  structures,  bones  as  well  as  mus- 
cles, tendons,  and  aponeuroses.  Occasionally, 
again,  as  when  a  ball  is  lodged  in  an  extrem- 
ity, its  presence  is  easily  detected  by  the 
patient,  who  may  make  such  an  examination 
as  he  lies  in  bed. 

The  situation  of  the  foreign  body  having 


MILITARY    SURGERY.  11 

been  ascertained,  the  bullet-forceps,  seen  in  the 
accompanying  engraving,  take 
the   place  of  the  probe,  the 
blades,  which  should  be  long 
and  slender,  being  closed  un- 
til they  come  in  contact  with 
the  ball,  when  they  are  ex- 
panded so  as  to  grasp  it,  care 
being  taken  not  to  include  any 
of  the  soft  tissues.     If  there 
be  any  loose  or  detached  splin- 
ters of  bone,  wadding,  or  other 
foreign  material,  it  should  now 
also  be  removed ;  it  being  con- 
stantly borne  in   mind   that, 
while  a  ball  may  occasionally 
become    encysted,  and   is    at 
all  times,  if  smooth,  a  com- 
paratively   harmless    tenant,  i 
such  substances  always  keep! 
up     irritation,     and     should,! 
therefore,  if  possible,  be  got* 
rid  of  without  delay. 

Although  preference  is  commonly  given  to 
the  bullet-forceps,  properly  so  called,  as  an 
extractor,  the  polypus  and  dressing-forceps, 


72  A   MANUAL    OF 

represented  in  the  annexed  figures,  generally 
answer  quite  as  well,  espe- 
cially the  former,  the  latter 
being  adapted  only  to  cases 
where  the  foreign  body  is 
situated  a  short  distance 
below  the  surface,  or  where 
the  wound  is  of  unusual 
dimensions,  admitting  of  the 
free  play  of  the  instrument. 
During  the  extraction, 
the  parts  should  be  pro- 
perly supported,  and  if  the 
wound  is  not  large  enough 
for  the  expansion  of  the  in- 
strument, it  must  be  suitably 
enlarged.  When  the  ball  is 
lodged  a  short  distance  from 
the  skin,  it  may  often  be 
readily  reached  by  a  coun- 
ter-opening. 

When  a  bullet  is  imbed- 
ded in  a  bone,  as  in  the  head 
of  the  tibia,  or  in  the  con- 
dyles  of  the  femur,  and  the  parts  are  not  so 
much  injured  as  to  demand  amputation,  ex- 


MILITARY    SURGERY.  73 

traction  may  be  effected  with  the  aid  of  the 
trephine  and  elevator.  Sometimes  a  bullet- 
worm,  as  it  is  termed,  an  instrument  similar 
to  that  used  in  drawing  a  ball  from  a  gun, 
will  be  very  convenient  for  its  removal. 


The  operation  being  completed,  the  parts 
are  placed  in  an  easy,  elevated  position,  and 
enveloped  in  tepid,  cool  or  cold  water-dress- 
ings, as  may  be  most  agreeable  to  them  and 
to  the  system.  The  best  plan,  almost  always,  is 
to  leave  the  opening  or  openings,  made  by  the 
ball,  free,  to  favor  drainage  and  prevent  pain 
and  tension.  If  the  track  be  very  narrow,  it 
may  heal  by  the  first  intention,  but  in  general 
it  will  suppurate,  and  portions  of  tissue  may 
even  mortify.  Erysipelas,  pyemia,  and  se- 
condary hemorrhage  are  some  of  the  bad 
consequences  after  gunshot  injuries,  the  latter 
usually  coming  on  between  the  fifth  and  ninth 
day,  the  period  of  the  separation  of  the 
sloughs. 

7* 


74  A   MANUAL    Of 

CHAPTER  VI. 
Amputations  and  Resections, 

IN  endeavoring  to  decide  so  important  a 
question  as  the  loss  of  a  limb,  various  circum- 
stances are  to  be  considered,  as  the  age,  habits 
and  previous  health  of  the  patient,  the  kinds 
of  injury,  and  the  number,  nature,  and  im- 
portance of  the  tissues  involved.  In  military 
practice  amputation  must  often  be  performed 
in  cases  where  in  civil  practice  it  might  be 
avoided. 

It  may  be  assumed,  as  a  rule,  that  young 
adults  bear  up  under  severe  accidents  and 
operations,  other  things  being  equal,  much 
better  than  children  and  elderly  subjects ;  the 
strong  than  the  feeble;  the  temperate  than 
the  intemperate  ;  the  residents  of  the  country 
than  the  inhabitants  of  the  crowded  city. 

The  following  circumstances  may  be  enumer- 
ated as  justifying,  if  not  imperatively  demand- 
ing, amputation  in  cases  of  wounds,  whatever 
may  be  their  nature  : — 


MILITARY   SURGERY.  75 

1st.  When  a  limb  has  been  struck  by  a 
cannon  ball  or  run  over  by  a  railroad  car, 
fracturing  the  bones,  and  tearing  open  the 
soft  parts,  amputation  should,  as  a  general 
rule,  be  performed,  even  when  the  injury 
done  to  the  skin  and  vessels  is  apparently 
very  slight,  experience  having  shown  that 
such  accidents  seldom  do  well,  if  an  attempt 
is  made  to  save  the  limb,  the  patient  soon 
dying  of  gangrene,  pyemia,  or  typhoid  irrita- 
tion. The  danger  of  an  unfavorable  termina- 
tion in  such  a  case  is  always  greater  when  the 
lesion  affects  the  lower  extremity  than  when 
it  involves  the  superior. 

2d.  No  attempt  should  be  made  to  save  a 
limb  when,  in  addition  to  serious  injury  done 
to  the  integuments,  muscles,  or  bones,  its 
principal  artery,  vein,  or  nerve  has  been  ex- 
tensively lacerated,  or  violently  contused,  as 
the  result  will  be  likely  to  be  gangrene,  fol- 
lowed by  death. 

3d.  A  lacerated  or  gunshot  wound  pene- 
trating a  large  joint,  as  that  of  the  knee  or 
ankle,  and  accompanied  by  comminuted  frac- 
ture, or  extensive  laceration  of  the  ligaments 
of  the  articulation,  will,  if  left  to  itself,  be 


76  A   MANUAL    OF 

very  prone  to  terminate  in  mortification,  and 
is  therefore  a  proper  case  for  early  amputa- 
tion. 

4th.  Gunshot  wounds  attended  with  severe 
comminution  of  the  bones,  the  fragments 
being  sent  widely  around  among  the  soft 
parts,  lacerating  and  bruising  them  severely, 
generally  require  amputation,  especially  in 
naval  and  military  practice. 

5th.  Extensive  laceration,  contusion,  and 
stripping  off  of  the  integuments,  conjoined 
with  fracture,  dislocation,  or  compression  and 
purification  of  the  muscles,  will,  in  general, 
be  a  proper  cause  for  the  removal  of  a  limb.* 

Amputation  is  not  to  be  performed,  in  any 
case,  until  sufficient  reaction  has  taken  place 
to  enable  the  patient  to  bear  the  additional 
shock  and  loss  of  blood.  As  long  as  he  is  dead- 
ly pale,  the  pulse  small  and  thready,  the  sur- 
face cold,  and  the  thirst,  restlessness,  and  jacti- 
tation excessive,  it  is  obvious  that  recourse  to 
the  knife  must  be  wholly  out  of  the  question. 
The  proper  treatment  is  recumbency,  with 
mild  stimulants,  sinapisms  to  the  extremities, 
and  other  means  calculated  to  re-excite  the 

*  Gross's  Surgery,  vol.  i.  p.  895. 


MILITARY   SURGERY.  77 

action  of  the  heart  and  brain.  Power  being 
restored,  the  operation,  if  deemed  necessary, 
is  proceeded  with,  due  regard  being  had  to 
the  prevention  of  shock  and  hemorrhage,  the 
two  things  now  mainly  to  be  dreaded. 

One  of  the  great  obstacles  about  immediate 
amputation  is  the  difficulty  which  the  surgeon 
so  often  experiences  in  respect  to  the  cases 
demanding  the  operation,  and  the  uncertainty 
that  none  of  the  internal  organs  have  sus- 
tained fatal  injury ;  a  circumstance  which 
would,  of  course,  contra-indicate  the  pro- 
priety of  such  interference. 

Cases  occur,  although  rarely,  where,  not- 
withstanding the  most  violent  injury,  or  per- 
haps, even  the  loss  of  a  limb,  there  is  hardly 
any  appreciable  shock,  and,  in  such  an  event, 
the  operation  should  be  performed  on  the  spot. 

The  results  of  the  military  surgery  in  the 
Crimea  show  that  the  success  of  amputations 
was  very  fair  when  performed  early,  but  most 
unfortunate  when  they  were  put  off  for  any 
length  of  time.  This  was  the  case,  it  would 
seem,  both  in  the  English  and  French  armies. 

Should  amputation  ever  be  performed  in 
spreading  gangrene?  The  answer  to  this 


78  A   MANUAL    OP 

question  must  depend  upon  circumstances. 
We  may  give  our  sanction  when  the  disease, 
although  rapid,  is  still  limited,  and  when  the 
patient,  comparatively  stout  and  robust,  has 
a  good  pulse,  with  no  serious  lesion  of  a  vital 
organ  and  no  despair  of  his  recovery,  but  a 
cheerful,  buoyant  mind,  hopeful  of  a  favora- 
ble issue.  No  operation  is  to  be  done  when 
the  reverse  is  the  case ;  if  it  be,  the  patient 
will  either  perish  on  the  table,  from  shock 
and  hemorrhage,  or  from  a  recurrence  of 
mortification  in  the  stump. 

Lacerated,  contused,  and  gunshot  wounds 
are  often  of  so  frightful  a  nature  as  to  render 
it  perfectly  certain,  even  at  a  glance,  that  the 
limb  will  be  obliged  to  be  sacrificed  in  order 
that  a  better  chance  may  be  afforded  for  pre- 
serving the  patient's  life.  At  other  times, 
the  injury,  although  severe,  may  yet,  appar- 
ently, not  be  so  desperate  as  to  preclude,  in 
the  opinion  of  the  practitioner,  the  possibility 
of  saving  the  parts,  or,  at  all  events,  the  pro- 
priety of  making  an  attempt  to  that  effect. 
The  cases  which  may  reasonably  require  and 
those  which  may  not  require  interference  with 
the  knife  are  not  always  so  clearly  and  dis- 


MILITARY   SURGERY.  79 

tinctly  defined  as  not  to  give  rise,  in  very 
many  instances,  to  the  most  serious  and  un- 
pleasant apprehension,  lest  we  should  be 
guilty,  on  the  one  hand,  of  the  sin  of  com- 
mission, and,  on  the  other,  of  that  of  omis- 
sion ;  or,  in  other  and  more  comprehensive 
terms,  that,  while  the  surgeon  endeavors  to 
avoid  Scylla,  he  may  not  unwittingly  run  into 
Charybdis,  mutilating  a  limb  that  might  have 
been  saved,  and  endangering  life  by  the  re- 
tention of  one  that  should  have  been  promptly 
amputated.  It  is  not  every  man,  however 
large  his  skill  and  experience,  that  is  always 
able  to  satisfy  himself,  even  after  the  most 
profound  deliberation,  what  line  of  conduct 
should  be  pursued  in  these  trying  circum- 
stances; hence  the  safest  plan  for  him  gener- 
ally is  to  procure  the  best  counsel  that  the 
emergencies  of  the  case  may  admit  of.  But 
in  doing  this,  he  must  be  careful  to  guard 
against  procrastination ;  the  case  must  be  met 
promptly  and  courageously ;  delay  even  of  a 
few  hours  may  be  fatal,  or,  at  all  events,  place 
limb  and  life  in  imminent  jeopardy.  Above 
all,  let  proper  caution  be  used  if  the  patient 
is  obliged  to  be  transported  to  some  hospital, 


80  A   MANUAL    OF 

or  to  a  distant  home,  that  he  may  not  be 
subjected  to  unnecessary  pain,  exposed  to  loss 
of  blood,  or  carried  in  a  position  incompatible 
with  his  exhausted  condition.  Vast  injury  is 
often  done  in  this  way,  by  ignorant  persons 
having  charge  of  the  case,  and  occasionally 
even  by  practitioners  whose  education  and 
common  sense  should  be  a  sufficient  guarantee 
against  such  conduct. 

Little  need  be  said  here  about  the  methods 
of  amputation.  In  cases  of  emergency,  where 
time  is  precious,  and  the  number  of  surgeons 
inadequate,  the  flap  operation  deserves,  in  my 
opinion,  a  decided  preference  over  the  circular, 
and,  in  fact,  over  every  other.  The  rapidity 
with  which  it  may  be  executed,  the  abundant 
covering  which  it  affords  for  the  bone,  and  the 
facility  with  which  the  parts  unite  are  qualities 
which  strongly  recommend  it  to  the  judgment 
of  the  military  surgeon.  The  flaps  should  be 
long  and  well  shaped,  and  care  taken  to  cut 
off  the  larger  nerves  on  a  level  with  the  bone, 
in  order  to  guard  against  the  occurrence  of 
neuralgia  after  the  wound  is  healed.  What- 
ever method  be  adopted,  a  long  stump  should 
be  aimed  at,  that  it  may  afford  a  good  lever- 


MILITARY   SURGERY.  81 

age  for  the  artificial  substitute.  No  blood 
should  be  lost  during  or  after  the  operation, 
and  hence  the  main  artery  of  the  limb  should 
always  be  thoroughly  compressed  by  a  tourni- 
quet, not  by  the  fingers  of  assistants,  who  are 
seldom,  if  ever,  trustworthy  on  such  occasions. 

Anaesthetics  should  be  given  only  in  the 
event  of  thorough  reaction ;  so  long  as  the 
vital  powers  are  depressed  and  the  mind  is 
bewildered  by  shock,  or  loss  of  blood,  their 
administration  will  hardly  be  safe,  unless  the 
greatest  vigilance  be  employed,  and  this  is 
not  always  possible  on  the  field  of  battle,  or 
even  in  the  hospital.  Moreover,  it  is  astonish- 
ing what  little  suffering  the  patient  generally 
experiences,  when  in  this  condition,  even  from 
a  severe  wound  or  operation. 

In  the  war  in  the  Crimea,  the  British 
used  chloroform  almost  universally  in  their 
operations;  the  French  also  exhibited  it  very 
extensively,  and  Baudens,  one  of  their  leading 
military  surgical  authorities,  declares  that  they 
did  not  meet  with  one  fatal  accident  from  it,  al- 
though it  was  given  by  them,  during  the  East- 
ern campaign,  thirty  thousand  times  at  least. 
The  administration  of  chloroform  is  stated 
8 


82  A   MANUAL  OF 

by  Macleod  to  have  contributed  immensely  to 
the  success  of  primary  amputations. 

The  dressings  should  be  applied  according 
to  the  principles  laid  down  under  the  head 
of  wounds.  The  sutures,  made  with  silver 
wire  or  fine  silk,  should  not  be  too  numerous, 
and  the  adhesive  strips  must  be  so  arranged 
as  to  admit  of  thorough  drainage.  A  band- 
age should  be  applied  from  above  downward, 
to  control  muscular  action  and  afford  sup- 
port to  the  vessels;  the  stump  rest  upon  a 
pillow  covered  with  oil-cloth,  and  the  water- 
dressing  be  used  if  there  is  danger  of  over- 
action.  Pain  and  spasm  are  allayed  by 
anodynes ;  traumatic  fever,  by  mild  diapho- 
retics. Copious  purging  is  avoided;  the 
drink  is  cooling ;  and  the  diet  must  be  in 
strict  conformity  with  the  condition  of  the 
patient's  system.  The  first  dressings  are  re- 
moved about  the  end  of  the  third  day;  after 
that  once  or  even  twice  a  day,  according  to 
the  nature  and  quantity  of-  the  discharges, 
accumulation  and  bagging  being  faithfully 
guarded  against. 

The  following  statistics  of  amputations,  both 
in  the  continuity  of  the  limbs  and  of  the 


MILITARY   SURGERY.  83 

articulations,  possess  peculiar  interest  for  the 
military  surgeon.  They  are  derived  chiefly 
from  a  review  which  I  published  of  Mr. 
Macleod's  "Notes  of  the  Surgery  in  the 
Crimea"  in  the  North  American  Medico- 
Chirurgical  Review  for  January,  1860. 

The  number  of  cases  given  by  Macleod  is 
732, with  a  mortality  of  201.  Of  these,  654  were 
primary,  with  165  deaths,  or  26'22  per  cent.; 
and  78  secondary,  with  36  deaths,  or  in  the 
ratio  of  46'1.  The  mortality  of  the  greater 
amputations — as  those  of  the  shoulder,  arm, 
and  forearm,  and  the  hip,  thigh,  knee,  and 
leg — was  39*8  per  cent,  for  the  primary  opera- 
tions, and  60  per  cent,  for  the  secondary. 

The  increase  of  mortality  from  amputa- 
tions as  we  approach  the  trunk  has  long  been 
familiar  to  surgeons,  and  the  results  in  the 
Crimea  have  not  changed  our  previous  knowl- 
edge. Thus  the  ratio  of  mortality  of  ampu- 
tations of  the  fingers  was  0*5 ;  of  the  forearm 
and  wrist,  1-8;  of  the  arm,  22'9 ;  of  the 
shoulder,  27'2;  of  the  tarsus,  14-2;  of  the 
ankle-joint,  22-2;  of  the  leg,  30-3;  of  the 
knee-joint,  50*0 ;  and  of  the  thigh,  in  its 
lower  third,  50'0,  at  its  middle,  55'3,  at  the 


84  A  MANUAL   OP 

upper  part,  86-8,  and  at  the  hip,  100-0.  The 
limb  was  removed  at  the  latter  joint  in  10 
cases,  all  of  which  rapidly  proved  fatal.  The 
French  had  13  cases,  primary  and  secondary, 
with  no  better  luck. 

Legouest  has  published  a  table  of  most  of 
the  recorded  cases  of  amputation  at  the  hip- 
joint,  for  gunshot  wounds.  Of  these  30  were 
primary,  and  all  ended  fatally;  of  11  inter- 
mediate, or  early  secondary,  3  recovered; 
and  of  3  remote,  1  recovered.  "Thus,"  says 
Macleod,  "if  we  sum  up  the  whole,  we  have 
4  recoveries  in  44  cases,  or  a  mortality  of 
90 '9  per  cent."  Some  of  the  primary  cases 
died  on  the  table ;  and  all  the  rest,  except 
two,  before  the  tenth  day.  In  the  Schleswig- 
Holstein  war,  amputation  at  the  hip-joint  was 
performed  seven  times,  with  one  cure.  Mr. 
Sands  Cox,  recording  the  experience  of  civil 
and  military  hospitals  up  to  1846,  gives  84 
cases,  most  of  them  for  injury,  with  26  re- 
coveries. Dr.  Stephen  Smith,  of  New  York, 
has  published  tables  of  98  cases,  showing  a 
ratio  of  mortality  of  1  in  2f .  In  62  of  these 
cases,  the  operation  was  performed  in  30  for 
injury,  with  a  mortality  of  60  per  cent. 


MILITARY   SURGERY.  85 

Amputation  in  the  upper  third  of  the  t high 
was  performed  39  times,  with  a  fatal  result  in 
34.  Of  these  cases  only  one  was  secondary, 
and  that  perished.  Amputation  of  the  mid- 
dle third  of  the  limb  was  performed  in  65 
cases,  of  which  38  died.  Of  these  cases  56 
were  primary,  with  31  deaths,  giving  thus  a 
mortality  of  53-3  per  cent. ;  9  cases  were 
operated  upon  at  a  later  period,  and  of  these, 
7  died,  or  77*7  per  cent.  Amputation  of  the 
lower  third  of  the  thigh  was  performed  60 
times,  46  being  primary,  with  a  mortality  of 
50  per  cent.,  and  14  secondary,  with  a  mor- 
tality of  71*4  per  cent. 

Amputation  at  the  knee  was  performed 
primarily  in  6  cases,  of  which  3  died, 
and  once  secondarily,  with  a  fatal  result. 
Chelius  refers  to  37  cases  of  amputation  of 
the  knee,  collected  by  Jaeger,  of  which  22 
were  favorable;  and  of  18  cases  recorded  by 
Dr.  Markoe,  of  New  York,  as  having  occurred 
in  the  practice  of  American  surgeons,  13  got 
well.  These  cases,  added  together,  afford  an 
aggregate  of  61,  with  a  mortality  of  21,  or 
34'4  per  cent. 

The  leg  was  amputated  101  times,  with  36 
8* 


86  A  MANUAL   OF 

deaths,  or  a  mortality  of  35*6  per  cent.  Of 
these  cases  89  were  primary,  with  28  deaths, 
and  12  secondary,  with  8  deaths. 

Amputation  at  the  ankle-joint  was  per- 
formed in  12  cases,  death  following  in  2.  Of 
these  cases  3  were  secondary,  and  all  favor- 
able. 

The  arm  was  removed  at  the  shoulder-joint 
in  39  cases,  with  a  fatal  issue  in  13,  or  33*3 
per  cent.,  33  being  primary,  with  9  deaths, 
and  6  secondary,  with  a  fatal  issue  in  4.  If 
we  couple  these  cases  with  21  that  occurred 
during  the  previous  period  of  the  war,  we 
shall  have  an  aggregate  of  60  cases,  with  19 
deaths,  or  a  mortality  of  31*6  per  cent.  The 
advantage  of  primary  over  secondary  ampu- 
tation of  the  shoulder  has  long  been  known  to 
military  surgeons.  Thus,  of  19  primary  cases 
mentioned  by  Mr.  Guthrie  as  having  occurred 
between  June  and  September,  1813,  18  re- 
covered, while  of  19  secondary  cases  15  died. 
The  experience  of  the  late  Dr.  Thomson,  in 
Belgium,  is  equally  decisive. 

Amputation  of  the  upper  arm  was  per- 
formed 102  times,  with  death  in  25  cases,  or 
a  mortality  of  24*5 ;  96  of  the  cases  being 


MILITARY    SURGERY.  87 

primary.     Of  the  6  secondary  cases  one-half 
proved  fatal. 

The  forearm  was  amputated  primarily  52 
times,  and  the  hand  at  the  wrist  once,  with 
only  1  death ;  while  of  7  secondary  opera- 
tions upon  the  same  parts,  2  died. 

Resection  is  one  of  the  aids  of  conserva- 
tive surgery,  and  military  practice  affords 
numerous  occasions  for  its  employment.  The 
operation,  however,  is  not  equally  applicable 
to  all  the  articulations.  Resection  of  the 
shoulder -joint  has  hitherto  afforded  the  most 
flattering  results.  It  is  more  especially  ap- 
plicable in  cases  of  gunshot  injuries,  unat- 
tended by  serious  lesion  of  the  vessels  and 
nerves  of  the  limb,  or  severe  laceration  of 
the  muscles  and  integuments.  A  portion  of 
the  humerus,  embracing,  if  necessary,  from 
four  to  five  inches  in  length,  together  with  a 
part  or  even  the  whole  of  the  glenoid  cavity 
of  the  scapula,  may  be  safely  and  expe- 
ditiously  removed  under  such  circumstances, 
and  yet  the  patient  have  an  excellent  use  of 
his  arm. 

Williams   mentions    19    cases   of  gunshot 


88  A   MANUAL   OF 

wounds  of  the  shoulder-joint  in  which  resec- 
tion was  performed,  of  which  3  proved  fatal. 
Baudens  saved  13  out  of  14  cases,  and  the 
British  surgeons  in  the  Crimea  lost  2  patients 
only  out  of  27. 

Resection  of  the  elbow  has  of  late  engaged 
much  attention  among  military  men,  and  al- 
though the  results  are  less  flattering  than  in 
the  operation  upon  the  shoulder,  they  are, 
nevertheless,  highly  encouraging.  Of  82 
cases  which  occurred  in  the  Schleswig-Hol- 
stein  and  in  the  Crimean  campaigns,  only  16 
died,  or  1  in  about  5. 

The  wrist- joint  has  seldom  been  the  subject 
of  excision ;  doubtless,  cases  not  unfrequently 
occur  in  which  it  might  be  resorted  to  with 
advantage. 

Dr.  George  Williams  has  collected  the  his- 
tory of  11  cases  of  excision  of  the  hip- joint 
for  gunshot  injury,  6  of  which  occurred  in 
the  Crimea.  Of  this  number  10  died.  Of 
23  amputations  at  the  hip-joint  by  the  Eng- 
lish and  French  surgeons  in  the  East,  all  died. 

Excision  of  the  knee-joint  for  gunshot  in- 
jury holds  out  no  prospect  of  advantage, 
experience  having  shown  that,  when  the  ar- 


MILITARY    SURGERY.  89 

ticulating  extremities  of  the  femur  and  tibia 
are  fractured  by  a  ball,  the  proper  remedy  is 
amputation. 

The  ankle-joint  has  been  resected  in  a  few 
instances  only  for  gunshot  injuries,  and  the 
results  have  thus  far  been  by  no  means  flat- 
tering. When  the  joint  is  seriously  impli- 
cated, amputation  will  undoubtedly  be  the 
more  judicious  procedure. 

Resection  of  the  bones  in  their  continuity 
is  seldom  practiced  in  this  class  of  injuries, 
and  experience  has  offered  nothing  in  its 
favor.  The  operation  was  performed  several 
times  in  the  Crimea,  but  proved  invariably 
fatal. 

The  after-treatment  in  resection  must  be 
conducted  upon  the  same  principles  as  in 
amputation.  The  measures  must,  for  the 
most  part,  be  of  a  corroborating  nature.  The 
limb  must  be  placed  in  an  easy  position,  and 
be  well  supported  by  a  splint  or  fracture-box, 
to  prevent  motion.  The  operation  is  liable 
to  be  followed  by  the  same  bad  effects  as 
amputations. 


90  A   MANUAL   OF 


CHAPTER  VII. 
Ill  Consequences  of  Wounds  and  Operations. 

THE  bad  consequences  to  be  apprehended 
after  wounds,  amputations,  and  other  opera- 
tions, are  traumatic  fever,  hemorrhage,  excess- 
ive suppuration,  spasm,  erysipelas,  gangrene, 
pyemia,  and  tetanus. 

a.  Traumatic  fever  usually  sets  in  within 
the  first  few  hours  after  the  injury,  or  soon 
after  reaction  has  been  fairly  established.  In 
camp  practice  its  tendency  generally  is  to 
assume  a  low  typhoid  character,  especially  if 
there  is  much  crowding  of  the  sick,  with  im- 
perfect ventilation  and  want  of  cleanliness. 
Not  unfrequently  it  displays  an  endemic  or 
epidemic  disposition. 

The  treatment  must  be  exceedingly  mild ; 
the  patient  will  not  bear  depletion,  but  will, 
notwithstanding  his  fever,  probably  require 
stimulants  and  tonics,  with  nutritious  food  and 
drink  from  the  very  commencement.  A  gentle 


MILITARY   SURGERY.  91 

anodyne  and  diaphoretic  mixture,  as  morphia 
and  antimony  in  camphor-water,  may  be  need- 
ful, in  the  early  stage,  to  quell  the  fictitious 
excitement  or  attempt  at  overaction. 

b.  The    likelihood   of    secondary   hemor- 
rhage must  be  steadily  kept  in  view  in  these 
cases ;  much  may  be  done  to  prevent  it  by 
the  proper  use  of  the  ligature  at  the  time  of 
the    operation   or   dressing,  but   it   is  often 
unavoidable,  especially  in   gunshot  wounds, 
owing  to  the  injury  sustained  by  the  coats  of 
the  vessels  by  the  grazing  of  the  ball.    How- 
ever   induced,   it    should    receive   the   most 
prompt  attention,  inasmuch  as  the  loss  even 
of  a  few  ounces  of  blood  may  prove  destruc- 
tive to  the  already  exhausted  system. 

c.  Spasm  of  the  muscles  is  not  peculiar  to 
amputations ;  it  often  exists  in  a  most  severe 
degree   in   cases  of  fractures   and   gunshot 
wounds.    Anodynes  in  full  doses,  with  a  little 
antimony,  the  use  of  a  moderately-tight  band- 
age, and  warm  water-dressing,  medicated  with 
laudanum  and  acetate  of  lead,  are  the  most 
appropriate  measures. 

d.  Profuse  suppuration  may  be  looked  for 
in  nearly  all  bad  wounds,  whatever  their  char- 


92  A   MANUAL   OF 

actor,  and  also  in  many  of  the  amputations 
performed  on  the  field  of  battle.  The  ex- 
hausting effects  must  be  counteracted  by  sup- 
porting remedies,  as  quinine,  iron,  cod-liver 
oil,  and  brandy,  with  frequent  change  of 
dressing,  cleanliness,  and  ventilation.  Bag- 
ging is  prevented  by  counter-openings  and 
careful  bandaging. 

e.  Erysipelas  usually  manifests  itself  with- 
in the  first  thirty-six  hours  after  the  injury 
or  operation;  often  assumes  an  endemic  or 
epidemic  character ;  is  easily  distinguished  by 
the  peculiar  reddish  blush  rapidly  spreading 
over  the  surface,  together  with  the  stinging 
or  smarting  pain  and  increased  swelling;  and 
should  be  treated  with  dilute  tincture  of  iodine, 
or  anodyne  and  saturnine  lotions,  quinine  and 
tincture  of  iron,  with  nutritious  food  and 
drinks. 

/.  Q-angrene  is  sufficiently  common  after 
severe  lesions  on  the  battle-field,  especially 
that  variety  of  it  denominated  hospital  gan- 
grene. During  the  Crimean  war,  this  form 
of  gangrene  raged  with  extraordinary  viru- 
lence and  fatality  among  the  French  in  the 
hospitals  on  the  Bosphorusu  It  also  prevailed 


MILITARY   SURGERY.  93 

about  the  same  period  within  some  of  the  hos- 
pitals in  the  south  of  France,  and  it  is  as- 
serted that  the  "Euphrate,"  a  transport 
ship,  in  her  voyage  to  the  Mediterranean  was 
obliged,  from  this  cause  alone,  to  throw  sixty 
of  her  men  overboard  within  thirty-six  hours  ! 
After  the  taking  of  the  Quarries  and  the  as- 
sault upon  the  Redan,  during  the  heat  of 
summer,  in  1855,  the  English  surgeons  lost 
a  number  of  their  cases  of  amputation  of  the 
thigh  from  moist  gangrene  of  a  most  rapid 
character,  the  system  having  been  literally 
everwhelmed  by  the  poison.  When  hospital 
gangrene  is  endemic,  it  attacks  not  only  open 
wounds  and  sores,  but  also  the  slightest 
scratches,  cicatrices,  and  stumps.  Persons 
laboring  under  diarrhoea,  dysentery,  and 
scurvy  are  most  obnoxious  to  it. 

The  proper  remedies  are  sequestration  of 
the  patients,  the  free  use  of  the  nitric  acid  lo- 
tion, iodine  to  the  inflamed  skin,  charcoal,  port 
wine,  or  yeast  cataplasms,  and  frequent  ablu- 
tions with  disinfecting  fluids,  aided  by  opium, 
quinine,  tincture  of  iron,  lemon-juice,  and 
other  supporting  means.  Mopping  the  af- 
9 


94  A   MANUAL   OF 

fected  surface  freely  with  strong  nitric  acid 
often  answers  an  excellent  purpose.  The 
favorite  remedy  of  Pouteau  was  the  actual 
cautery. 

g.  Pyemia,  the  purulent  infection  of  the 
French  writers,  is  one  of  the  chief  dangers 
after  severe  wounds  and  operations.  It  was 
the  great  source  of  the  mortality  after  ampu- 
tations, especially  secondary,  during  the  war 
in  the  Crimea.  It  usually  comes  on  within 
from  three  to  eight  days  after  the  injury,  and 
is  nearly  always  fatal.  Its  characteristic 
symptoms  are  rigors,  followed  by  copious 
sweats,  rapid  failure  of  the  vital  powers,  de- 
lirium, and  a  withered  appearance  of  the 
countenance,  frequently  conjoined  with  an 
icterode  tinge  of  the  eye  and  skin.  On  dis- 
section, the  large  veins  leading  from  the 
stump  or  wound  are  found  filled  with  pus, 
with  redness  of  the  lining  membrane ;  and 
abscesses,  usually  small  and  filled  with  un- 
healthy fluid,  are  seen  scattered  through  the 
lungs,  muscles,  and  cellular  substance,  mat- 
ter also  occasionally  existing  in  the  joints. 
The  treatment  is  essentially  the  same  as '  in 
erysipelas. 


MILITARY   SURGERY.  95 

h.  Traumatic  tetanus  is  not  very  common 
in  military  practice.  It  is  most  liable  to 
show  itself  in  tropical  countries,  in  hot,  damp 
weather,  and  in  persons  of  a  nervous,  irritable 
temperament,  occasionally  supervening  upon 
the  most  insignificant  injuries,  as,  for  exam- 
ple, a  mere  scratch.  In  India  the  disease  is 
often  provoked  by  unextracted  balls,  and  both 
in  that  country  and  on  the  continent  of  Eu- 
rope the  operation  which  was  most  frequently 
followed  by  it,  during  the  recent  wars,  was 
amputation  at  the  shoulder-joint. 

The  effects  of  sudden  vicissitudes  of 
temperature  in  developing  tetanus,  are  well 
known.  They  are  most  striking  in  tropical 
regions,  when  the  change  is  from  hot  to  cold, 
or  from  dry  to  wet.  Larrey  had  repeated 
opportunities  of  observing  the  development 
of  the  disease  under  such  circumstances,  both 
in  Egypt  and  Germany.  After  the  battle  of 
Bautzen,  the  exposure  of  the  wounded  to  the 
cold  night  air. produced  over  a  hundred  cases 
of  tetanus,  and  a  large  number  suffered  from 
a  similar  cause  after  the  battle  of  Dresden. 
Like  effects  were  witnessed  at  Ferozepore 
and  Chillian wallah.  Baudens,  in  his  treatise 


96  A   MANUAL  OF 

on  gunshot  wounds,  states  that  the  influence 
of  cold  and  moisture  in  developing  the  disease, 
during  the  French  campaigns  in  Africa,  was 
most  striking.  Of  forty  slightly  wounded 
men,  placed  in  a  gallery  on  the  ground  floor, 
during  the  prevalence  of  a  northeasterly 
wind,  fifteen  were  speedily  attacked  with 
tetanus.  Similar  effects  have  several  times 
been  noticed  in  this  country.  Thus,  after 
the  battle  of  Ticonderoga,  in  1758,  nine  of 
the  wounded  who  were  exposed  the  whole 
night  after  the  action,  in  open  boats  upon 
Lake  George,  died  of  locked-jaw;  and  during 
our  war  with  Great  Britain,  most  of  those 
who  suffered  on  board  the  Amazon,  in  the 
engagement  before  Charleston,  were  attacked 
with  this  disease  a  fortnight  after,  in  conse- 
quence of  a  very  sudden  change  of  weather, 
the  wind  blowing  cold  and  wet. 

The  extremes  of  heat  and  cold  both  favor 
the  production  of  tetanus.  In  the  East  and 
West  Indies,  the  slightest  prick  of  the  finger 
or  toe  is  often  sufficient  to  induce  the  disease, 
and  the  inhabitants  of  the  Arctic  regions  not 
unfrequently  suffer  in  a  similar  manner.  Dr. 
Kane,  in  his  memorable  expedition,  lost  two 


MILITARY   SURGERY.  97 

of  his  men  from  this  affection,  and  he  adds 
that  all  his  dogs  perished  from  a  like  cause. 

The  mortality  from  traumatic  tetanus  is 
notorious.  Hardly  one  recovers.  Nearly 
all  perish  in  two  or  three  days  from  the 
attack. 

The  most  reliable  remedies  are  opium, 
in  the  form  of  morphia  or  acetated  tinc- 
ture, in  large  doses,  in  union  with  camphor 
and  antimony.  The  effects  of  Indian  hemp 
are  uncertain.  Chloroform  will  mitigate  pain 
and  spasm.  Amputation,  except,  perhaps, 
when  the  wound  affects  a  finger  or  toe,  will  be 
worse  than  useless,  as  will  also  be  counter-irri- 
tation along  the  spine.  To  prevent  the  disease 
should  be  our  business,  and  to  do  this  no 
wounded  person  should  ever  be  exposed  to 
the  cold  night  air,  or  to  currents  of  air  at 
any  time.  After  all  amputations,  however 
trifling,  special  directions  should  be  given 
upon  this  point. 

9* 


98  A   MANUAL   OF 


CHAPTER  VIII. 
Injuries  of  the  Head,  Chest,  and  Abdomen. 

THE  immediate  effects  of  concussion  of  the 
brain  are  those  of  fainting  or  collapse,  and 
must  be  treated  accordingly ;  by  recumbency, 
access  of  cold  air,  the  use  of  the  fan,  dashing 
of  cold  water  upon  the  face  and  chest,  and 
sinapisms  to  the  precordial  region,  thighs,  feet, 
and  spine,  aided,  in  the  more  severe  cases,  by 
stimulating  injections.  If  the  patient  can 
swallow,  he  may  take  a  little  wine  or  brandy. 
A  smelling-bottle  may  be  held  near,  not  to, 
the  nose.  Reaction  is  not  promoted  too 
rapidly,  for  fear  of  secondary  consequences. 

The  period  of  danger  from  collapse  being 
over,  the  patient  is  sedulously  watched,  that 
overaction  may  not  occur,  the  risk  now  being 
from  inflammation ;  or,  the  stage  of  excite- 
ment being  happily  passed,  from  the  remote 
effects  of  the  injury.  If  the  concussion  was 


MILITARY    SURGERY.  99 

at  all  severe,  all  bodily  and  mental  excite- 
ment must  be  for  a  long  time  avoided. 

Compression  of  the  brain  arises,  surgically 
speaking,  from  two  causes  only :  effusion  of 
blood,  and  depressed  bone.  In  the  former 
case,  the  characteristic  symptoms  —  insensi- 
bility and  coma,  dilated  and  fixed  pupil, 
stertorous  breathing,  and  paralysis  —  fre- 
quently do  not  come  until  some  time  after 
the  receipt  of  the  injury.  The  first  symp- 
toms will  probably  be  those  of  concussion,  or 
exhaustion.  By-and-by,  the  patient  regains 
his  senses  and  his  strength,  gets  up,  talks, 
or  walks,  and  then  suddenly  drops  down,  as 
if  he  had  been  shot,  in  a  state  of  utter  un- 
consciousness. The  effusion  of  blood,  kept  in 
abeyance  during  the  collapse,  has  had  full 
play,  filling  empty  places,  and  causing  unmis- 
takable effects.  Such  an  occurrence  will  be 
most  apt  to  happen  when  there  has  been  ex- 
tensive separation  of  the  dura  mater,  or  rup- 
ture of  the  middle  meningeal  artery.  If,  on 
the  other  hand,  the  compression  is  due  to  de- 
pression of  the  skull,  the  symptoms  are  nearly 
always  immediate. 

When  the  case  is  one  of  sanguineous  com- 


100  A  MANUAL   OP 

pression,  it  must  be  treated  very  much  as 
one  of  ordinary  apoplexy ;  at  first,  by 
efforts  at  gradual  reaction,  and  afterward 
by  purgatives,  bleeding,  and  means  to  favor 
cerebral  accommodation  and  prevent  inflam- 
mation. The  trephine  is  not  thought  of 
unless  the  unconsciousness  obstinately  per- 
sists, and  there  is  reason  to  believe,  from 
the  nature  of  the  phenomena,  especially  the 
existence  of  a  wound  or  contusion  on  the 
head,  that  the  blood  may  be  reached  by  the 
instrument. 

Grunshot  injuries  of  the  skull,  with  or 
without  lodgment  of  the  ball,  may  be  pro- 
ductive merely  of  concussion  of  the  brain,  or 
of  concussion  and  compression.  When  the 
missile  penetrates  the  bone,  and  tears  up  the 
cerebral  tissues  and  membranes,  death  usually 
occurs  instantly,  or  within  a  short  time  after 
the  receipt  of  the  accident,  without,  perhaps, 
any  attempt  at  reaction.  Nevertheless,  a 
number  of  cases  of  injury  of  this  nature,  in 
which  the  patient  either  partially  or  com- 
pletely recovered,  have  been  recorded  by 
military  surgeons.  In  some  instances  the 
ball  merely  penetrates  the  skull,  with  no 


MILITARY    SURGERY.  101^ 

apparent  depression,  and  in  this  event  the 
treatment  should  evidently  be  very  simple, 
being  limited,  in  great  degree,  after  the  occur- 
rence of  reaction,  to  the  prevention  of  inflam- 
mation of  the  brain.  A  similar  course  should 
be  adopted  when  the  bone  is  broken  and  only 
slightly  depressed,  especially  if  there  be  no 
urgent  or  obstinate  symptoms  of  compression. 
When,  on  the  contrary,  the  bone  is  badly 
fractured,  comminuted,  or  forced  greatly 
beyond  the  natural  level,  the  proper  plan  is 
to  trephine,  whether  there  be  any  external 
wound  or  evidences  of  compression  or  not. 
If  the  operation  be  neglected,  loss  of  life 
from  inflammation  will  be  sure  to  arise  within 
the  first  six  or  ten  days  after  the  receipt  of 
the  injury.  In  the  punctured  fracture,  as  it 
is  named,  the  trephine  is  invariably  employed 
at  the  earliest  moment,  however  flattering, 
apparently,  the  head  symptoms  may  be.  If 
the  instrument  be  withheld,  fatal  cerebritis  or 
arachnitis  will  be  no  less  certain  than  when 
the  bone  is  shattered  and  driven  down  upon 
the  brain. 

Fracture  of  the  skull  by  centre-coup,  so 
common  in  civil  practice,  is  seldom  met  with 


102 


,A  .MANUAL  OP 


on  the  field  of  battle ;  doubtless  for  the  rea- 
son that  the  injury  is  hardly  ever  inflicted 
upon  the  top  or  base  of  the  cranium,  as  it  is 
when  a  person  is  struck  upon  the  vertex  or 
falls  upon  his  nates.  The  most  frequent 
fracture  among  soldiers  is  the  punctured.  A 
ball  has  been  known  to  break  the  internal 
table  of  the  skull  without  the  external. 

The  skull  is  sometimes  frightfully  injured 
without  any  serious  lesion  of  the  scalp. 
Macleod  refers  to  a  case,  which  occurred  at 
the  Alma,  where  it  was  completely  destroyed 
by  a  glancing  shot,  without  any  material 
implication  of  the  soft  parts.  A  round  shot 
("  en  ricochet")  struck  the  scale  from  an 
officer's  shoulder,  and  merely  grazed  his  head 
as  it  ascended.  The  result  was  instant  death. 
The  skull  was  so  completely  mashed  that 
its  fragments  rattled  under  the  scalp  as  if 
loose  in  a  bag.  The  condition  of  the  brain 
was,  unfortunately,  not  ascertained. 

In  the  more  simple  forms  of  fractures  of 
the  skull,  however  induced,  the  practice  of 
trephining  is  now  much  less  common  than 
formerly,  and  there  is  no  doubt  that  the 
patient  often  makes  a  good  recovery,  though 


MILITARY   SURGERY.  103 

it  is  by  no  means  certain  that  such  a  person 
may  not  suffer  seriously,  at  a  more  or  less 
remote  period,  from  epileptic  and  other 
affections.  I  am  convinced  from  my  own 
observation  that  this  happens  not  unfre- 
quently.  Dr.  Stromeyer,  surgeon-in-chief  in 
the  Schleswig-Holstein  campaign  in  1849, 
expresses  strong  opposition  to  the  use  of 
the  trephine  in  gunshot  and  other  fractures 
of  the  skull,  even  with  depression,  on  the 
ground  that,  independently  of  the  mischief 
inflicted  in  the  operation  upon  the  tissues, 
admission  of  air  to  the  contused  portion  of 
the  brain  greatly  augments  the  danger  of 
inflammation.  Of  41  cases  of  gunshot  frac- 
tures of  the  skull  with  depression,  reported 
by  him,  34  were  cured,  and  of  these  1  only 
had  been  trephined. 

When  operative  interference  is  deemed  im- 
proper, the  most  simple  treatment  should  be 
enforced.  Any  probing  that  may  be  neces- 
sary should,  if  practicable,  be  performed  with 
the  finger,  and  the  wound  should  not  be  en- 
larged, except  when  we  are  compelled  to  ele- 
vate depressed  or  remove  loose  bone. 

When  trephining  is  required,  it  should  be 


104  A  MANUAL   OP 

done  as  early  as  possible,  and  without  chloro- 
form or  ether,  unless  the  patient  is  very  un- 
ruly, as  the  anaesthetic  might  tend  to  provoke 
inflammation  of  the  brain.  Every  particle  of 
depressed  bone  should  be  elevated,  and  such 
portions  as  are  loose,  detached,  or  driven  into 
the  brain,  and  easily  accessible,  removed.  All 
bleeding  vessels  are  tied,  the  edges  of  the 
wound  are  gently  approximated  with  silver 
sutures,  and  the  head,  well  shaved  and  raised, 
wrapped  in  warm  or  cold  water-dressing,  as 
may  be  most  grateful  to  part  and  system. 
The  great  danger  after  all  severe  injuries  and 
operations  upon  the  skull  is  inflammation  of 
the  brain  and  of  its  membranes,  and  to  the 
prevention  of  this,  therefore,  the  surgeon 
should  direct  his  most  zealous  efforts.  The 
patient  must  be  frequently  visited,  and  every 
untoward  symptom  promptly  met  by  appro- 
priate measures,  of  which  active  purgation, 
loss  of  blood  by  venesection,  leeching  or  cup- 
ping, a  restricted  diet,  and  exclusion  of  light 
and  noise  from  the  apartment,  with  perfect 
rest,  are  the  most  reliable. 

Wounds  of  the  brain  must  be  managed 
upon  general  principles ;  all  foreign  matter  is 


MILITARY   SURGERY.  105 

at  once  removed,  and  the  parts  being  restored 
as  nearly  as  may  be  to  their  normal  relations, 
the  surgeon  endeavors  to  keep  the  resulting 
inflammation  within  proper  limits.  Most  of 
such  lesions  prove  fatal  within  the  first  week 
from  their  receipt.  If  the  patient  survive  for 
any  length  of  time,  death  will  generally  come 
at  last  from  exhaustion,  cerebritis,  or  fungus. 

Portions  of  the  skull,  sliced  off  by  the 
sabre  or  sword,  should  be  immediately  re- 
placed and  secured  by  wire  sutures,  even  if 
they  are  attached  merely  by  small  shreds  of 
the  scalp. 

Scalp  wounds  of  every  description,  but  in 
particular  the  contused,  lacerated,  punctured, 
and  gunshot,  are  extremely  prone  to  be  fol- 
lowed by  erysipelas;  death  may  also  occur 
from  cerebritis,  arachnitis,  and  pyemia.  The 
slightest  lesion,  then,  of  this  region  of  the 
body  should  be  zealously  watched. 

Wounds  of  the  face  must  be  treated  with  an 
eye  to  the  avoidance  of  disfiguring  scars,  by 
wire  sutures  and  cold  water-dressing.  When 
a  large  portion  of  the  lower  jaw  is  shot  away, 
the  tongue  will  be  apt  to  fall  back  upon  the 
glottis,  causing  suffocation.  The  organ  should 
10 


106  A   MANUAL   OF 

be  drawn  forward  with  the  finger  or  tenacu- 
lum,  and  the  patient  observe  the  prone  posi- 
tion until  the  tendency  is  lost. 

One  of  the  great  sources  of  annoyance  and 
danger,  in  gunshot  wounds  of  the  face,  is 
secondary  hemorrhage.  It  frequently  ap- 
pears soon  after  the  accident,  and,  although 
it  often  ceases  spontaneously,  it  is  sometimes 
controlled  with  much  difficulty.  Paralysis, 
partial  or  complete,  is  not  uncommon,  owing 
to  injury  of  the  branches  of  the  facial  nerve. 

In  the  management  of  wounds  about  the 
mouth,  throat,  and  face,  great  care  must  be 
taken  not  to  allow  the  offensive  mucous  and 
salivary  secretions  to  pass  into  the  stomach. 
The  neglect  of  this  precaution  is  apt  to  be 
followed  by  a  low  typhoid  state  of  the  sys- 
tem, very  similar  to  what  occurs  in  pyemia, 
or  blood  poisoning.  I  have  repeatedly  wit- 
nessed these  effects  after  operations  upon  the 
jaws,  mouth,  and  even  the  nose. 

In  fractures  of  the  bones  of  the  face  from 
gunshot  an  exception  should  be  made  to  the 
general  rule  of  removing  fragments  which  are 
nearly  detached,  observation  having  shown, 
says  Mr.  Macleod,  that  the  large  supply  of 


MILITARY    SURGERY.  107 

blood  in  this  region  will  enable  them  to  re- 
sume their  connection  with  the  other  tissues, 
in  a  way  that  would  be  fatal  to  similarly 
placed  portions  in  other  situations. 

Gunshot  and  other  wounds  of  the  chest  are, 
as  stated  elsewhere,  extremely  fatal ;  death,  if 
the  lesion  be  at  all  severe,  being  usually 
speedily  caused  by  shock,  hemorrhage,  or  as- 
phyxia ;  or,  at  a  more  or  less  remote  period, 
by  inflammation  and  effusion.  When  the  lungs 
are  wounded,  the  characteristic  symptoms  will 
be  haemoptysis,  with  suffocative  cough,  great 
prostration,  and  excessive  alarm.  A  copious 
flow  of  blood  may  take  place  in  the  thoracic 
cavity  from  a  wound  of  one  of  the  intercostal 
arteries. 

Any  foreign  matter  that  is  easily  accessible 
is  at  once  removed,  but  officious  probing  is  out 
of  the  question.  The  wound,  if  small  and 
unaccompanied  by  serious  hemorrhage,  is 
closed  in  the  usual  manner,  the  chest  being 
firmly  encircled  by  a  broad  bandage,  to  com- 
pel diaphragmatic  respiration.  Under  oppo- 
site circumstances,  it  is  kept  open,  the  pa- 
tient lying  upon  the  affected  side  to  favor  the 
escape  of  blood,  with  as  much  elevation  of 


108  A   MANUAL   OF 

the  head  as  the  case  may  admit  of.  The  main 
reliance  for  arresting  pulmonary  bleeding  is 
upon  venesection,  copious,  and  frequently  re- 
peated, unless  the  exhaustion  amounts  to  abso- 
lute collapse.  Sugar  of  lead,  opium,  and  vera- 
trum  viride  are  frequently  exhibited,  sinapisms 
are  applied  to  the  extremities,  and,  in  short, 
everything  is  done  to  control  cardiac  action. 
Inflammatory  symptoms  are  counteracted  in 
the  usual  manner,  and  effused  fluids,  causing 
oppression,  and  resisting  ordinary  measures, 
are,  unhesitatingly,  evacuated  by  puncture, 
as  the  only  chance  of  escape. 

Wounds  of  the  heart  and  aorta,  of  whatever 
nature,  are  usually  fatal ;  now  and  then,  how- 
ever, an  astonishing  exception  occurs. 

Wounds  of  the  abdomen,  merely  penetrating 
its  walls,  but  not  its  contents,  are  brought  to- 
gether by  sutures  extending  down  nearly  to 
the  peritoneum,  otherwise  they  will  be  fol- 
lowed by  hernia.  When  they  involve  the 
intestine,  and  are  incised,  they  are  sewed  up 
with  a  fine  needle  and  silk  thread,  either  in- 
terruptedly or  continuously,  the  ends  of  the 
ligature  being  cut  off  close. 

Contusions  of  the  walls  of  the  abdomen  by 


MILITARY    SURGERY.  109 

round  shot  are  among  the  most  dangerous  in- 
juries to  which  the  body  is  exposed,  often 
rupturing  both  the  hollow  and  solid  viscera, 
and  rapidly  causing  death,  without  much  ap- 
parent sign  of  so  severe  an  accident.  The 
most  important  symptoms  of  these  contusions 
are  vomiting,  and  pain  in  the  abdomen ;  and 
the  great  object  of  the  treatment,  in  the  event 
the  patient  survives  their  immediate  effects, 
is  the  prevention  of  peritonitis,  which  often 
comes  on  in  the  most  stealthy  manner.  Lace- 
ration of  an  internal  organ  is  nearly  always 
promptly  fatal.  Shell  wounds  of  the  walls  of 
the  abdomen  are  generally  followed  by  exten- 
sive sloughing.  Abscesses  among  the  muscles 
of  the  abdomen  are  not  uncommon  after  gun- 
shot injuries. 

Balls  often  traverse  the  walls  of  the  abdo- 
men for  a  considerable  distance  without  en- 
tering its  cavity,  or  they  pass  in  without  in- 
juring any  of  the  contained  viscera. 

"  The  fatality  of  penetrating  wounds  of  the 
belly/'  observes  Macleod,  "will  depend  much 
on  the  point  of  their  infliction.  Balls  enter- 
ing the  liver,  kidneys,  or  spleen  are  well 
known  to  be  usually  mortal,  although  excep- 
10* 


110  A  MANUAL  OP 

tional  cases  are  not  rare.  Wounds  of  the 
great  gut  are  also  always  recognized  as  much 
less  formidable  than  those  which  implicate  the 
small.  Thomson  saw  only  two  cases  of  wounds 
of  the  small  gut,  after  Waterloo,  in  the  way 
of  recovery;  but  Larrey  reports  several. 
Gunshot  wounds  of  the  stomach  are  also  ex- 
ceedingly fatal.  Baudens  records  a  remark- 
able case  of  recovery,  although  complicated 
with  severe  head  injuries.  The  syncope  which 
followed  the  severe  hemorrhage  in  this  case 
lasted  for  ten  hours,  and  "doubtless  assisted, 
along  with  the  empty  state  of  the  stomach  at 
the  moment  of  injury,  in  preventing  a  fatal 
issue." 

Gunshot  wounds  of  the  bladder  occasionally 
occur;  the  ball  may  penetrate  the  organ  in 
any  direction,  and  at  the  same  time  commit 
extensive  havoc  in  the  neighboring  parts,  both 
soft  and  osseous.  Such  lesions  are  generally 
fatal.  Simple  gunshot  wounds,  on  the  con- 
trary, are  sometimes  recovered  from,  espe- 
cially when  they  are  treated  by  the  retention 
of  the  catheter,  thus  allowing  the  urine  to  flow 
off  as  fast  as  it  descends  from  the  kidneys. 
The  operation  of  laying  open  the  wounded 


MILITARY   SURGERY.  Ill 

viscus  through  the  perineum,  as  originally  pro- 
posed by  Dr.  Walker,  of  Massachusetts,  might 
be  performed  in  such  a  contingency.  Such  a 
procedure  would  be  much  more  likely  to  pre- 
vent urinary  infiltration  than  the  catheter, 
however  carefully  retained,  during  the  detach- 
ment of  the  sloughs,  as  well  as  before  the 
contiguous  structures  have  been  glazed  with 
lymph. 

Balls,  pieces  of  cloth,  fragments  of  bone, 
and  other  foreign  bodies,  if  retained  in  the 
bladder,  generally  serve  as  nuclei  of  calculi, 
and  should,  therefore,  be  as  speedily  extracted 
as  possible,  either  through  the  perineum,  or 
by  means  of  the  forceps  or  lithotriptor.  Quite 
a  number  of  cases,  in  which  the  operation  of 
lithotomy  was  successfully  performed  for  the 
purpose  of  effecting  the  riddance  of  balls 
and  other  extraneous  substances,  have  been 
reported  by  different  writers,  as  Morand, 
Larrey,  Baudens,  Langenbeck,  Guthrie,  and 
Hutin. 


112  A   MANUAL   OF 

i  •    :    '  - 

CHAPTER  IX. 
Diseases  Incident  to  Troops. 

THE  diseases  which  attend  armies,  or  molest 
soldiers  in  camps,  garrisons,  and  hospitals, 
and  which  so  often  decimate  their  ranks,  and 
even,  at  times,  almost  annihilate  whole  regi- 
ments, are  the  different  kinds  of  fevers,  espe- 
cially typhus  and  typhoid,  dysentery,  diar- 
rhoea, and  scurvy.  These  are,  emphatically, 
the  enemies  of  military  life,  doing  infinitely 
more  execution  than  all  the  weapons  of  war, 
however  adroitly  or  efficiently  wielded,  put 
together.  Pneumonia,  pleurisy,  and  hepati- 
tis, of  course,  slay  their  thousands,  and  vari- 
ous epidemics,  especially  cholera,  not  unfre- 
quently  commit  the  most  frightful  ravages. 
"  War,"  says  Johnson,  "  has  means  of  destruc- 
tion more  formidable  than  the  cannon  and  the 
sword.  Of  the  thousands  and  tens  of  thou- 
sands that  have  perished,  how  small  a  propor- 
tion ever  felt  the  stroke  of  an  enemy !"  Fred- 
erick the  Great  used  to  say  that  fever  cost 


MILITARY   SURGERY.  113 

him  more  men  than  seven  pitched  battles, 
and  it  has  long  been  a  matter  of  history  that 
more  campaigns  are  decided  by  sickness  than 
by  the  sword.  The  great  mortality  which 
attended  our  armies  in  Mexico  was  occa- 
sioned, not  by  wounds  received  in  battle,  but 
by  the  diseases  incident  to  men  carrying  on 
their  military  operations  in  an  inhospitable 
climate,  badly  fed,  subjected  to  fatiguing 
marches,  and  obliged  to  use  unwholsome 
water.  Thousands  perished,  during  their  ab- 
sence, from  fever,  dysentery,  and  diarrhoea, 
and  a  still  greater  number  from  the  effects  of 
these  diseases,  after  the  return  of  the  troops 
to  their  native  soil.  The  latter  affection,  in 
particular,  pursued  many,  like  a  relentless 
foe,  to  their  graves  long  after  they  had  been 
cheered  by  the  sight  of  their  homes  and  friends. 
In  the  war  in  the  Crimea  disease  destroyed 
incomparably  more  soldiers  than  the  sword, 
the  musket,  and  the  cannon.  Typhus  and 
typhoid  fever,  dysentery,  diarrhoea,  scurvy, 
and,  lastly,  malignant  cholera,  annihilated 
vast  numbers,  both  in  the  British,  French,  and 
Russian  ranks.  According  to  Dr.  Macleod, 
whose  "  Notes  on  the  Surgery  of  the  War  in 


114  A   MANUAL   OF 

the  Crimea,"  are  so  well  known  to  the  pro- 
fession,- the  proportion  of  those  lost  among 
the  British  by  sickness  to  those  lost  by  gun- 
shot and  other  injuries,  was,  during  the  entire 
campaign,  as  16,211  to  1761,  exclusive  of 
those  killed  in  action.  The  difference  he  sup- 
poses to  have  been  still  greater  among  the 
French  and  Russian  forces.  In  December, 
1854,  and  in  January,  1855,  not  less  than 
14,000  French  soldiers  were  admitted  into 
the  Crimean  ambulances  on  account  of  dis- 
ease, whereas,  during  the  same  period,  only 
1500  were  admitted  on  account  of  wounds. 
Of  the  whole  number  nearly  2000  died. 
During  the  last  six  months  of  the  campaign, 
in  which  the  city  was  stormed  and  taken,  the 
French  had  21,957  wounded  as  an  offset 
against  101,128  cases  of  disease.*  At  Wal- 
cheren,  in  1809,  the  British  lost  one-third  of 
their  troops  by  disease,  and  only  16  per  cent, 
by  wounds.  In  the  Peninsular  war,  from 
January,  1811,  to  May,  1814,  out  of  an  ef- 
fective force  of  61,500  men,  only  42-4  per 
1000,  says  Macleod,  were  lost  by  wounds, 
while  118-6  were  lost  by  disease. 

*  Macleod,  op.  cit.,  67. 


MILITARY    SURGERY.  115 

The  number  of  sick  that  may  be  expected 
to  be  constantly  on  hand  during  any  given 
campaign  is  estimated,  on  an  average,  at  10 
per  cent. ;  but  this  proportion  must  neces- 
sarily be  exceeded,  especially  in  an  invading 
army,  with  raw,  undisciplined,  and  unaccli- 
mated  troops.  This  was  eminently  true  even 
in  the  Crimea,  in  a  climate  comparatively 
healthy,  within  a  few  miles  of  the  sea.  We 
may  well  imagine  what  would  be  the  effects 
of  the  climate  of  the  South  upon  the  North- 
ern troops,  if  they  were  to  pass  far,  during  the 
hot  season,  beyond  Mason  and  Dixon's  line. 
Disease,  in  its  worst  form,  would  be  sure  to  in- 
vade and  thin  their  ranks  at  every  step.  Fever 
— typhoid,  typhous,  remittent,  intermittent, 
and  yellow  —  dysentery,  diarrhoea,  scurvy, 
pneumonia,  and  inflammation  of  the  liver 
would  accomplish  more,  infinitely  more,  for 
the  Southern  cause  than  all  the  weapons  of 
war  that  could  be  placed  in  the  hands  of  the 
Southern  people.  Typhoid,  typhus,  and  yel- 
low fever,  dysentery,  diarrhoea,  and  scurvy 
would,  in  all  human  probability,  soon  become 
epidemic,  and  occasion  a  mortality  truly  ap- 
palling. The  Southern  soldier,  on  the  con- 


116  A   MANUAL   OF 

trary,  thoroughly  acclimated  as  he  is,  would 
suffer  comparatively  little. 

The  British  in  the  Crimean  war  lost  5910 
men  from  diarrhoea  and  dysentery,  the  whole 
number  of  cases  having  been  52,442,  afford- 
ing thus  a  mortality  of  11 '26  per  cent.  Cho- 
lera, of  which  there  were  7575  cases  alto- 
gether, destroyed  4513,  or  in  the  ratio  of 
59*57  per  cent.  Typhus  fever  killed  285  out 
of  828  cases ;  fever,  not  typhus,  3161,  out  of 
30,376.  The  French  and  Russian  troops  suf- 
fered in  still  larger  numbers  from  these  dis- 
eases. Macleod  asserts  that  the  former  lost 
their  men  by  typhus  fever  by  thousands,  and 
the  latter  by  tens  of  thousands.  .  The  British 
suffered  but  little  from  intermittent  fever, 
whereas  this  disease  did  great  mischief  among 
the  French,  causing  serious  mortality,  either 
directly  or  indirectly,  besides  disqualifying 
large  numbers  for  service. 

Scurvy  was  another  dreadful  enemy  which 
the  British  and  French  troops  were  compelled 
to  encounter  in  the  Crimea.  It  prevailed 
more  or  less  extensively  for  a  long  time, 
and  served  to  impart  its  livery  to  the  other 
diseases  of  the  soldiery,  masking  their  char- 


MILITARY   SURGERY.  117 

acter,  and  remarkably  augmenting  their  viru- 
lency. 

Considering,  then,  the  frequency  of  the 
occurrence  of  these  diseases,  and  their  exces- 
sive fatality,  it  behooves  the  military  surgeon 
to  use  every  means  in  his  power  to  guard,  in 
the  first  place,  against  their  outbreak,  by  the 
employment  of  proper  hygienic  or  sanitary 
measures,  and,  in  the  next,  to  treat  them  with 
all  possible  diligence  and  judgment  when  their 
development  is  unavoidable.  It  is,  of  course, 
impossible,  in  a  work  of  this  description,  to 
enter  into  any  details  upon  the  subject ;  but 
there  are  several  points  which  cannot,  I  con- 
ceive, be  too  forcibly  impressed  upon  the 
mind  of  the  military  practitioner.  I  refer  to 
the  great,  the  paramount  importance  of — 
1st,  proper  isolation  of  the  sick,  or,  what  is 
the  same  thing,  the  importance  of  not  crowd- 
ing them  together ;  2dly,  free  ventilation ; 
3dly,  bodily  cleanliness ;  4thly,  little  medi- 
cine ;  5thly,  a  good  supply  of  fresh  vegeta- 
bles and  fruits,  especially  oranges  and  lemons ; 
Gthly,  careful  and  tender  nursing. 

Painful  experience  has  shown,  in  all  parts 
of  the  world,  that  the  crowding  together  of 
11 


118  A  MANUAL   OP 

the  sick  and  wounded  is  one  of  the  worst 
calamities  that  can  befall  them.  For  want 
of  this  precaution,  diseases,  otherwise  easily 
manageable,  often  assume  an  epidemic  char- 
acter, or,  in  the  absence  of  this  character, 
often  baffle  the  best  directed  efforts  for  their 
relief.  When  the  wounded  are  crowded  to- 
gether they  frequently  become  the  victims  of 
erysipelas,  hospital  gangrene,  pyemia,  and 
phlebitis ;  occurrences  which,  under  better 
regulations,  might  in  many  cases  be  entirely 
prevented. 

Of  the  propriety  of  constant  and  thorough 
ventilation,  it  is  unnecessary  to  speak.  If 
pure  air  is  so  essential  in  health,  it  is  easy 
enough  to  see  how  important  it  must  be  in 
sickness. 

Cleanliness  of  body  should  be  regarded  as 
a  religious  duty ;  it  may  be  effected  with  the 
sponge  and  tepid,  cool  or  cold  water,  accord- 
ing to  the  exigencies  of  the  case,  and  cannot 
be  performed  too  frequently  or  too  thoroughly, 
care  being,  of  course,  taken  not  to  worry  or 
fatigue  the  patient.  In  some  instances  the 
water  may  be  medicated  with  common  salt, 
potassa,  vinegar,  or  Labarraque's  solution. 


MILITARY   SURGERY.  119 

Nothing  is  generally  more  grateful  to  the 
sufferer,  in  the  different  kinds  of  fevers,  than 
frequent  sponging  of  the  surface  with  cool  or 
tepid  water. 

The  use  of  heroic  medicines,  or  of  any 
medicines  in  large  doses,  in  these  diseases, 
and  also  in  cases  of  severe  wounds,  cannot  be 
too  severely  reprobated.  More  men,  there  is 
reason  to  believe,  have  been  killed  in  this 
manner  in,  the  armies  and  navies  of  the 
world  than  by  the  sword  and  the  cannon. 
Let  medicines,  then,  be  administered  spar- 
ingly. Let  the  secretions  be  well  seen  to; 
but  purge  little,  and  use  depressants  with  all 
possible  wariness.  Give  iced  water,  but  not 
too  freely,  and  lumps  of  ice  when  there  is 
much  thirst  with  gastric  irritability  and  exces- 
sive restlessness.  Mild  diaphoretics  and  ano- 
dynes will,  as  a  general  rule,  be  highly  effica- 
cious, but  the  latter  should  be  exhibited  with 
great  caution  when  there  is  cerebral  oppres- 
sion. Lemon-juice  and  potassa  are  indispens- 
able in  scurvy,  or  where  there  is  a  marked 
tendency  to  scorbutic  disease.  Quinine  is  one 
of  the  great  remedies  in  most,  if  not  in  all,  of 
these  diseases,  especially  when,  as  is  so  often 


120  A   MANUAL    OF 

the  case,  they  are  associated  with  a  malarious 
origin.  The  good  average  dose  is  from  two 
to  five  grains,  repeated  from  three  to  five  times 
in  the  twenty-four  hours.  When  marked  de- 
bility prevails,  the  best  stimulants  are  brandy, 
in  the  form  of  milk-punch  or  toddy,  and  Ma- 
deira, Port,  or  Sherry  wine. 

Immense  suffering  and  loss  of  life  are  often 
occasioned  for  the  want  of  fresh  vegetables 
and  fruits  in  military  operations,  as  well  as 
in  the  garrison  and  the  hospital.  A  daily 
supply  of  these  articles  should,  therefore,  be 
provided  at  almost  any  hazard  and  expense. 
In  all  low  states  of  the  system,  however  in- 
duced, the  strength  can  never  be  rapidly 
brought  up  without  a  diet  which  partakes 
more  or  less  of  this  character. 

There  is  a  form  of  dysentery,  very  com- 
mon in  India,  which  is  exceedingly  apt,  when 
large  masses  of  troops  are  habitually  congre- 
gated together,  to  assume  an  epidemic  char- 
acter;  and  it  is  for  this  reason  that  it  has 
often  been  supposed  to  be  contagious.  For 
such  an  opinion,  however,  there  does  not  seem 
to  be  any  valid  reason.  Ballingall,  who  wit- 
nessed at  least  2000  cases  of  this  disease, 


MILITARY   SURGERY.  121 

asserts  that  he  never  once  met  with  a  circum- 
stance tending  to  create  such  a  suspicion;  and 
the  views  advanced  by  this  eminent  surgeon 
are  those  now  pretty  generally,  if  not  uni- 
versally, entertained  by  the  British  practi- 
tioners in  India. 

"The  remote  causes  of  dysentery  in  India 
are  conceived  to  be  heat,  particularly  when 
combined  with  moisture ;  the  immediate  and 
indiscriminate  use  of  fruits ;  the  abuse  of  spirit- 
uous liquors,  and  exposure  to  currents  of  wind 
and  to  noxious  night-dews."  Troops  recently 
arrived  from  Europe  are  particularly  prone 
to  the  disease. 

Tropical  dysentery  presents  itself  in  two 
varieties  of  form,  the  acute  and  the  chronic. 
The  first,  which  is  an  extremely  fatal  disease, 
is  seated  in  the  rectum  and  colon,  the  latter 
being  often  involved  through  nearly  its  en- 
tire extent,  and  it  frequently  commits  very 
serious,  if  not  irreparable,  mischief  in  these 
structures  before  the  patient  and  the  attend- 
ant are  aware  of  its  true  character,  owing  to 
the  absence  of  urgent  pain  and  pyrexia.  In 
general  the  attack  is  ushered  in  by  the  ordi- 
nary symptoms  of  diarrhoea,  such  as  griping 
11* 


122  A   MANUAL    OF 

pain  in  the  bowels  and  frequent  calls  to  stool 
with  excessive  straining,  the  evacuations 
being,  at  first,  thin  and  copious  but  without 
fetor  and  but  little  streaked  with  blood. 
The  tongue,  skin,  and  pulse  are  nearly,  per- 
haps entirely,  normal.  Gradually  the  pain 
becomes  more  violent,  as  well  as  more  fixed, 
and  is  felt  in  both  iliac  regions,  or  even  along 
the  whole  track  of  the  colon ;  the  discharges 
consist  chiefly  of  blood  and  mucus,  or  of  a 
fluid  resembling  water  in  which  fresh  beef 
has  been  macerated ;  the  tongue  is  covered 
with  a  white  coat ;  the  skin  is  either  hot  and 
dry,  or  bathed  with  clammy  perspiration ; 
and  the  straining  is  so  excessive  as  to  occa- 
sion prolapsus  of  the  rectum.  The  pulse  is, 
even  at  this  stage,  often  but  little  affected, 
being,  perhaps,  only  somewhat  increased  in 
quickness.  Sometimes,  however,  it  is  very 
full,  bounding,  and  vibratory,  without  much 
velocity,  and  when  this  is  the  case  it  al- 
ways, according  to  Ballingall,  forebodes  evil. 
Toward  the  close  of  the  attack,  the  passages 
are  frequently  involuntary  and  intolerably 
fetid,  gangrenous  portions  of  the  mucous 
coat  of  the  bowel  are  sometimes  extruded, 


MILITARY    SURGERY.  123 

and  the  surface  of  the  body  emits  a  peculiar 
cadaverous  smell.  The  average  period  at 
which  death  occurs  is  about  one  week,  but 
many  cases  linger  on  much  longer. 

The  remedies  upon  which  the  India  prac- 
titioners mainly  rely  in  the  treatment  of  this 
horrible  form  of  dysentery  are  venesection, 
mercury,  and  op^um,  leeches,  purgatives,  dia- 
phoretics, warm  bathing,  blisters,  and  ene- 
mata  being  employed  as  auxiliaries.  Vene- 
section is  always  practiced  early,  and,  even 
when  the  patient  is  not  very  robust,  boldly, 
it  being,  apparently,  regarded  as  the  sheet 
anchor  of  the  physician's  hope.  Calomel  is 
administered  in  doses  of  from  ten  to  twenty 
grains,  along  with  two  or  three  grains  of 
opium,  twice  or  thrice  in  the  twenty-four 
hours;  and,  while  profuse  salivation  is  dis- 
countenanced, production  of  slight,  ptyalism 
is  generally  aimed  at. 

Such  treatment  as  this  seems  altogether 
frightful  to  the  modern  American  practitioner; 
it  strikes  him  as  unnecessarily  harsh,  and  as 
well  calculated  to  augment  the  mortality  of 
the  disease.  We  might,  in  this  country,  per- 
haps bleed,  and  that  pretty  freely,  at  the 


124  A  MANUAL   OF 

very  commencement  of  an  attack  of  dysen- 
tery; at  all  events,  leech  very  copiously,  but 
we  would  certainly  draw  blood  sparingly  if 
the  attack  had  already  made  serious  constitu- 
tional inroads,  or  if  it  was  of  an  epidemic  char- 
acter; and,  as  to  giving  mercury  with  a  view 
to  ptyalism,  however  slight,  few  men  would, 
I  presume,  be  so  fool-hardy.  The  India  prac- 
titioners do  not,  it  appears,  employ  quinine  in 
the  treatment  of  this  form  of  dysentery;  a 
remedy  so  extremely  needful  in  many  cases 
of  this  disease  as  it  prevails  in  this  country, 
especially  in  our  Southern  latitudes,  where  it 
is  not  unfrequently  of  a  malarious  origin. 

The  chronic  form  of  India  dysentery,  termed 
hepatic  flux,  more  frequently  attacks  persons 
who  have  been  for  some  time  inured  to  the 
climate  of  that  country,  and  is  always  asso- 
ciated with  biliary  derangement.  "  This  flux, 
like  the  other,  often  assumes  at  its  commence- 
ment the  appearance  of  a  common  diarrhoea, 
and  becomes  afterward  characterized  by  fre- 
quent and  severe  fits  of  griping,  resembling 
colic  pains,  particularly  urgent  about  the 
umbilical  region.  Each  attack  of  griping  is 
generally  succeeded  by  a  call  to  stool,  and 


MILITARY   SURGERY.  125 

the  evacuations  are  always  unnatural  in  color 
and  consistence,  free  from  any  admixture  of 
blood,  but  generally  of  a  yeasty  or  frothy  ap- 
pearance, and  accompanied  with  large  dis- 
charges of  flatus ;  while  in  passing  they  are 
attended  with  a  sense  of  scalding  about  the 
anus.  The  patient,  after  each  evacuation, 
feels  considerably  relieved,  and  hopes  to  enjoy 
an  interval  of  ease,  but  the  recurrence  of  the 
griping,  accompanied  with  a  sensation  of  air 
passing  through  the  bowels,  and  succeeded 
again  by  a  call  to  stool,  give  him  little 
respite.  From  the  commencement  of  the 
attack,  the  patient  complains  of  nausea,  want 
of  relish  for  his  food,  and  preternatural  thirst, 
attended  often  with  a  disagreeable  taste  in  the 
mouth.  The  tongue  is  furred  or  loaded,  and 
not  unfrequently  covered  with  a  yellow  bilious 
coat.  The  pulse  is  quickened  and  the  skin 
parched."* 

Cholera  morbus  must,  necessarily,  in  this 
country,  especially  in  our  Southern  latitudes, 
and  during  the  hot  summer  months,  be  a  more 
or  less  frequent  attendant  upon  camp  life, 
although  much  may  be  done,  by  a  proper  ob- 

*  Ballingall's  Military  Surgery,  p.  511,  1844. 


126  A   MANUAL    Or 

servance  of  hygienic  laws,  to  prevent  it. 
When  the  disease  breaks  out  it  cannot  be 
arrested  too  speedily.  The  most  appropriate 
remedies,  particularly  in  its  earlier  stages, 
are  perfect  quietude,  abstinence  from  drink, 
sinapisms  to  the  epigastrium,  and  an  efficient 
dose  of  morphia  and  camphor,  or  even  mor- 
phia alone.  If  torpor  of  the  liver  exist,  blue 
mass  or  a  few  grains  of  calomel  may  be  ad- 
vantageously combined  with  the  anodyne. 
The  swallowing  of  small  lumps  of  ice  will 
greatly  assist  in  allaying  the  gastric  irrita- 
bility. A  mustard  and  salt  emetic  will  be  in- 
dicated if  the  stomach  is  loaded  with  ingesta. 
The  bowels  are  quieted  with  an  anodyne 
enema ;  and,  to  relieve  thirst  and  reduce  heat 
of  skin,  the  surface  is  frequently  sponged 
with  cool  or  tepid  water.  A  combination  of 
carbonate  of  potassa  and  acetated  tincture  of 
opium,  with  fresh  lemon-juice,  in  peppermint 
or  camphor  water,  will  often  act  like  a  charm 
in  relieving  the  gastric  and  intestinal  irri- 
tability, the  cramps,  and  other  distressing 
symptoms. 

The  exposure  of  the  soldier,  both  in  the 
tent  and  on  the  field,  renders  him  extremely 
prone  to  rheumatism,  frequently  attended 


MILITARY   SURGERY.  127 

with  high  inflammatory  excitement  and  severe 
pain.  Such  an  attack  is  often  effectually  put 
to  flight  if,  at  its  inception,  it  be  treated  with 
a  large  anodyne  and  diaphoretic  mixture,  as 
fifteen  grains  of  Dover's  powder,  a  third  to 
half  a  grain  of  sulphate  of  morphia  with  a 
fourth  of  a  grain  of  tartar  emetic,  or,  what 
is  perhaps  still  better,  a  drachm  of  the  wine 
of  colchicum  in  union  with  a  full  dose  of 
morphia  or  black  drop.  When  the  disease 
has  already  made  some  progress,  an  active 
purgative  should  precede  the  exhibition  of 
these  medicines. 

Sore  throat,  tonsillitis,  and  catarrhal  affec- 
tions, or,  what  in  common  language  are  called 
colds,  are  very  common  among  soldiers,  espe- 
cially the  raw  troops  just  mustered  into  ser- 
vice, ill  clothed,  inexperienced,  and  unaccus- 
tomed to  camp  life.  The  moment  such  disease 
sets  in,  no  matter  how  light  it  may  be,  the 
person  should  be  compelled  to  report  him- 
self at  the  surgeon's  quarters,  in  order  that 
he  may  receive  the  necessary  attention  and 
advice.  Generally  an  attack  of  this  kind  will 
promptly  yield  to  a  trifling  prescription,  as  a 
little  hot  drink,  a  mild  aperient,  or,  better 


128  A   MANUAL   OF 

still,  a  quarter  of  a  grain  of  morphia,  a  grain 
of  opium,  or  a  large  dose  of  Dover's  powder. 

In  an  army  not  under  strict  discipline,  or 
where  proper  care  is  not  observed  in  enlist- 
ing, mania  d  potu  is  very  apt  to  show  itself, 
much  to  the  annoyance  of  the  nurses  and  the 
physicians.  If,  in  such,  a  case,  the  patient  be 
not  well  secured,  he  may,  in  his  perverted 
military  ardor,  do  serious  mischief  to  himself 
and  to  his  attendants.  A  moderately  active 
mercurial  purge  at  the  outset  of  the  disease 
will  often  go  far  in  quieting  the  system  and 
in  abridging  the  attack.  After  the  medicine 
has  operated,  a  mild  opiate  and  sedative 
treatment  will  generally  be  the  most  soothing. 
Alcoholic  stimulants  are,  in  general,  to  be 
withheld. 

Nostalgia  is  another  complaint  liable  to 
assail  the  soldier,  even  the  hardiest,  especially 
if  he  is  a  person  of  strong  domestic  attach- 
ments, or  engaged  in  an  "  affaire  du  coeur."  It 
is  most  apt  to  show  itself  in  soldiers  enlisting 
for  the  foreign  service,  or  in  those  who  are 
forcibly  expatriated,  and  is  often  attended 
with  great  suffering,  terminating  in  confirmed 
melancholy.  It  is  characterized  by  a  love  of 


MILITARY   SURGERY.  129 

solitude,  a  vacant,  stultified  expression  of  the 
countenance,  a  morose,  peevish  disposition, 
absence  of  mind,  pallor  of  the  cheeks;  and 
progressive  emaciation.  Many  of  Bonaparte's 
troops,  during  the  campaign  in  Egypt,  suf- 
fered from  this  complaint;  some  in  a  very 
distressing  degree.  In  this  country,  nostal- 
gia will  not  be  likely  to  occur,  at  least  not  to 
any  extent,  as  our  people  are  essentially  of  a 
roving  habit,  and  of  an  eminently  social  dis- 
position. The  treatment  is  rather  moral  than 
medical ;  agreeable  amusements,  kindness, 
gentle  but  incessant  occupation,  and  the  pro- 
mise of  an  early  return  to  home  and  friends 
constituting  the  most  important  means  of 
relief. 

It  is  impossible,  even  under  the  most  rigid 
discipline,  to  prevent  gonorrhoea  among  sol- 
diers. They  will  expose  themselves,  in  spite 
of  all  that  can  be  done  to  prevent  it,  and 
they  often  pay  a  heavy  penalty  for  their  in- 
dulgence, not  only  from  the  suffering  entailed 
by  the  primary  disease,  but  its  different  com- 
plications, especially  chordee,  cystitis,  and 
orchitis.  The  symptoms  of  gonorrhoea  are 
too  well  understood  to  require  enumeration 
12 


130  A    MANUAL    OP 

here.  The  treatment  should,  from  the  start, 
be  rigidly  antiphlogistic;  by  rest,  low  diet, 
active  purgation,  and  the  antimonial  and  sa- 
line mixture,  with  the  addition  of  a  small 
quantity  of  copaiba.  The  penis  and  scrotum 
are  well  supported,  and  covered  with  warm 
water-dressing,  the  former  organ  being  bathed 
in  tepid  salt  water,  at  least  thrice  daily,  for 
twenty  minutes  at  a  time.  When  the  dis- 
charge is  greatly  lessened,  but  not  till  then, 
recourse  is  had  to  injections  of  lead,  sulphate 
of  zinc,  or  nitrate  of  silver,  at  first  very  mild 
and  gradually  increased  in  strength,  repeated 
every  six,  eight  or  twelve  hours.  The  treat- 
ment is  continued,  in  a  modified  form,  for 
about  five  days  after  all  the  specific  symp- 
toms have  vanished. 

Chordee  is  best  relieved  by  a  full  anodyne, 
as  half  a  grain  of  morphia,  in  union  with  the 
fourth  of  a  grain  of  tartar  emetic,  given  to- 
ward bedtime;  or  by  a  large  enema  of  lau- 
danum, with  warm  water-dressings  to  the 
genitals. 

For  the  relief  of  cystitis  the  most  appro- 
priate remedies  are  anodyne  diaphoretics,  in 
the  form  of  Dover's  powder,  or  a  solution  of 


MILITARY   SURGERY.  131 

morphia  and  tartar 'emetic,  aided  by  the  free 
use  of  bicarbonate  of  soda  and  moderate 
quantities  of  diluents. 

Orchitis  is  treated  by  suspension  of  the 
affected  organ,  with  strong  lead  and  anodyne 
lotions,  and  the  judicious  exhibition  of  anti- 
mony, in  union  with  morphia  or  black  drop. 

Chancres  must  be  thoroughly  cauterized  at 
the  beginning,  either  with  nitrate  of  silver, 
nitric  acid,  or  acid  nitrate  of  mercury;  and 
subsequently,  or  after  the  disease  has  made 
some  progress,  like  any  common  sore,  with 
mild  measures;  mercury  being  studiously 
withheld,  except  in  the  hard  form  of  the  disease, 
but  not  even  then  while  there  is  much  inflam- 
mation or  inordinate  constitutional  excite- 
ment. In  a  word,  all  harsh  measures  must 
be  avoided.  The  patient  will  generally  do  a 
thousand  times  better  without  than  with 
mercury.  The  greatest  possible  attention 
must  be  paid  to  cleanliness,  and  for  this  pur- 
pose the  parts  should  be  frequently  bathed  in 
tepid  salt  water,  aided  by  the  syringe  if  there 
be  a  tight  prepuce.  The  best  local  applica- 
tion is  the  warm  water-dressing,  covering  in 
the  entire  genitals ;  if  much  swelling  and  pain 


132  A   MANUAL    OF 

are  present,  it  may  be  advantageously  medi- 
cated with  lead  and  opium.  As  the  inflam- 
mation subsides,  the  sore  may  be  dressed  with 
some  gently  stimulating  lotion,  as  two  grains 
of  tannin,  the  eighth  of  a  grain  of  sulphate 
of  copper,  and  half  a  drachm  of  laudanum  to 
the  ounce  of  water,  a  weak  mixture  of  sherry 
and  water,  or  a  solution  of  nitrate  of  silver, 
zinc,  or  iodide  of  iron.  If  the  ulcer  is  dis- 
posed to  spread,  or  presents  a  sloughy  or 
unhealthy  aspect,  it  will  be  proper  to  touch  it 
lightly  twice  a  day  with  the  solid  nitrate  of 
silver,  or  a  solution  of  one  part  of  acid  nitrate 
of  mercury  to  four  parts  of  water. 

The  constitutional  treatment  is  rigidly 
antiphlogistic,  or  tonic  and  supporting,  ac- 
cording to  the  particular  nature  of  the  case. 
The  bowels  should  receive  early  attention ; 
the  skin  be  kept  moist ;  and  pain  be  allayed  by 
anodynes.  Perfect  recumbency  should  be 
observed  until  the  parts  are  nearly  healed. 
If  mercury  be  required,  the  best  forms  will 
be  calomel  and  blue  mass,  in  small  doses  twice 
a  day,  with  a  vigilant  eye  to  their  effects,  pty- 
alism  being  studiously  avoided  in  every  case. 

If  bubo  supervene,  the  treatment  must  be 


MILITARY   SURGERY.  133 

prompt  and  efficient,  with  a  view  to  the  pre- 
vention of  further  mischief.  Recumbency,  the 
topical  use  of  iodine  with  warm  water-dress- 
ing medicated  with  lead  and  opium,  light  diet, 
and  the  antimonial  and  saline  mixture  con- 
stitute the  most  appropriate  measures.  If 
matter  form,  an  early  and  free  incision  is 
made,  and  the  part  afterward  treated  as  a 
common  sore,  the  granulating  process  being 
promoted  by  mild  means.  Mercury  is  care- 
fully withheld,  at  all  events  in  the  early  stage 
of  the  disease. 

The  army  is  no  place  for  soldiers  laboring 
under  secondary  or  tertiary  syphilis;  the 
sooner  they  are  dismissed  from  the  service 
the  better,  especially  if  they  are  volunteers. 

Ophthalmia  is  one  of  the  annoyances  of 
the  soldier's  life.  Liable  to  be  caused  by 
cold,  it  is  capable  of  assuming  several  varie- 
ties of  form,  and  sometimes  prevails  exten- 
sively as  an  epidemic.  The  granular  and 
purulent,  in  particular,  are  to  be  feared, 
as  they  frequently  destroy  the  sight,  and 
even  the  eye,  in  a  few  days,  occasioning  in- 
tense suffering.  To  ascertain  the  condition 
of  the  parts,  the  lids  must  always  be  gently 
12* 


134  A   MANUAL   OP 

everted  with  a  probe  or  the  finger.  The  great- 
est cleanliness  should  be  observed  in  these  Af- 
fections; the  patients  should,  if  possible,  be 
sequestered,  at  all  events  not  be  permitted  to 
use  the  same  basins  and  towels ;  the  light  should 
be  excluded  from  the  apartment;  and  the  gen- 
eral and  local  treatment  should  either  be  strictly 
antiphlogistic  or  of  a  mixed  character,  partly 
antiphlogistic  and  partly  stimulant.  The 
applications  should  be  of  the  mildest  descrip- 
tion, especially  those  intended  for  the  inflamed 
surface.  The  syringe  is  frequently  used  to 
wash  away  the  secretions.  Strong  collyria 
generally  do  immense  harm  in  all  forms  and 
stages  of  ophthalmia.  Blood  may  be  taken 
from  the  arm,  or  by  cups  or  leeches  from  the 
temples,  if  the  symptoms  are  unusually  urgent 
and  the  patient  plethoric.  In  rheumatic  in- 
flammation of  the  eye,  colchicum  and  morphia, 
given  freely  at  bedtime,  will  be  of  immense 
service. 

When  foreign  matter  gets  into  the  eye,  or 
becomes  imbedded  in  the  cornea,  speedy  re- 
moval must  be  effected,  and  the  parts  after- 
ward treated  with  rest,  cold  or  tepid  bathing, 
gentle  aperients,  and  seclusion  from  light. 


MILITARY   SURGERY.  135 

Particles  of  steel  and  other  sharp  bodies  are 
picked  out  with  the  point  of  a  delicate  bis- 
toury, or  cataract  needle.  The  effects  of 
lime  and  other  alkalies  are  neutralized  by 
syringing  the  eye  freely  with  a  weak  solution 
of  vinegar;  those  of  nitrate  of  silver,  with  a 
weak  solution  of  common  salt,  a  thorough 
coating  of  olive  oil  being  afterward  applied. 

Carbuncles,  boils,  and  abscesses,  which  are 
of  frequent  occurrence  in  army  practice,  de- 
mand prompt  attention,  both  on  account  of 
the  suffering  they  induce  and  the  disqualifi- 
cation they  may  entail  for  temporary  duty. 
They  should  be  opened  early  and  freely,  and 
no  time  be  lost  in  amending  the  general  health 
by  gentle  mercurial  and  other  purgatives,  alter- 
ants and  tonics,  particularly  quinine  and  iron. 
The  most  appropriate  topical  remedies  are 
tincture  of  iodine  and  warm  water-dressings. 

In  carbuncles  the  affected  structures,  after 
free  division,  will  generally  require  the  thor- 
ough application  of  some  escharotic  or  deter- 
gent stimulant,  as  Vienna  paste,  nitric  acid, 
nitrate  of  silver,  or  acid  nitrate  of  mercury. 

Frost-bite  is  extremely  common  among  sol- 
diers during  the  cold,  wet  weather  of  winter. 


136  A  MANUAL    OF 

Thousands  of  the  French  troops  perished 
from  this  cause  in  Russia,  during  Napoleon's 
retreat  from  Moscow.  Frost-bite  was  very 
prevalent  among  the  English  during  their 
first  winter  in  the  Crimea,  and  the  French 
suffered  in  still  greater  numbers,  as  well  as 
more  severely.  The  habit  which  the  men  had 
of  sleeping  in  their  wet  boots,  at  one  time 
almost  universal,  contributed  greatly  to  its 
production,  wet  and  cold  combined  diminish- 
ing the  circulation  and  vitality  of  the  feet 
and  toes.  On  the  21st  of  January,  1855, 
when  the  thermometer  stood  at  5°,  not  less 
than  2500  cases  of  frost-bite  were  admitted 
into  the  French  ambulance,  and  of  these  800 
died,  death  in  many  having  no  doubt  been 
expedited  by  the  effects  of  erysipelas,  pyemia, 
and  hospital  gangrene.  Weak  and  intemper- 
ate persons  are  most  apt  to  have  frost-bite 
and  to  perish  from  its  effects. 

In  the  treatment,  in  incipient  cases,  cloths, 
wrung  out  of  cold  water  impregnated  with  a 
little  spirits  of  camphor  or  alcohol,  should  be 
applied,  or  the  parts  be  covered  for  a  few  min- 
utes with  snow,  or  immersed  in  cold  water.  On 
no  account  must  they  be  exposed  to  warmth, 


MILITARY   SURGERY.  13T 

either  moist  or  dry.  Excessive  reaction  is  con- 
trolled by  lead  and  laudanum  lotions,  or  dilute 
tincture  of  iodine.  If  gangrene  occurs,  the  ordi- 
nary measures,  local  and  general,  are  indicated. 
All  rude  manipulation  in  dressing  the  injured 
part  greatly  aggravates  the  disease.  In  gen- 
eral, spontaneous  amputation  is  waited  for, 
experience  having  shown  that  operative  inter- 
ference, even  when  the  part  is  perfectly  black, 
and  attached  only  by  a  few  living  shreds,  is 
extremely  prone  to  be  productive  of  excessive 
pain  and  constitutional  irritation,  often  pro- 
ceeding to  an  alarming  extent. 

Among  the  great  evils,  both  of  civil  and 
military  practice,  are  bed-sores,  which,  unless 
the  greatest  possible  precaution  be  used,  are 
sure  to  arise  during  the  progress  of  acute 
diseases  and  of  severe  accidents,  necessitating 
protracted  recumbency.  The  hips  and  sacral 
region  are  their  most  common  sites,  with  the 
heel  in  cases  of  fractures  of  the  leg.  The 
earlier  symptoms  are  a  sense  of  prickling, 
as  if  the  part  were  rubbed  with  coarse  salt, 
or  a  burning,  itching  or  smarting  pain,  with 
a  brownish  or  livid  discoloration  of  the  skin, 
and  slight  swelling.  Then  gangrene  ensues, 
followed  by  horrible  suffering. 


138  A  MANUAL  OF 

To  prevent  these  sores,  which  often  prove 
destructive  to  life,  when  there  is  already  much 
exhaustion  from  previous  suffering,  the  pos- 
terior surface  of  the  body  should  be  fre- 
quently examined,  particularly  if  the  patient 
is  in  a  state  of  mental  torpor,  and  pains  taken 
to  ward  off  pressure  by  the  use  of  air  cush- 
ions and  other  means.  The  parts  should  be 
sponged  several  times  a  day  with  some  alco- 
holic lotion  containing  alum,  or  painted  with 
a  weak  solution  of  iodine.  If  gangrene  or 
ulceration  occurs,  a  yeast  or  port  wine  poul- 
tice is  used,  the  separation  of  the  slough  is 
aided  with  the  knife,  while  the  granulating 
process  is  promoted  by  the  usual  remedies. 

Ulcers  of  the  leg  are  causes  of  disqualifi- 
cation in  enlisting,  but  they  sometimes  occur 
after  the  soldier  has  entered  the  service,  from 
fatigue,  injury,  or  undue  constriction  of  the 
limb.  However  induced,  they  should  be  man- 
aged as  any  other  forms  of  inflammation,  re- 
cumbency with  elevation  of  the  affected  parts, 
tepid  water-dressings,  a  restricted  diet,  and 
cooling  purgatives  constituting  the  most  im- 
portant elements  of  the  treatment.  When 
the  healing  process  has  fairly  commenced,  the 


MILITARY   SURGERY.  139 

leg  should  be  supported  with  the  roller,  or 
adhesive  strips. 

As  preventive  of  ulcers  of  the  legs,  the 
limbs  should  be  daily  washed  in  cold  water 
with  Castile  soap,  and  no  soldier  should  be 
permitted  to  wear  garters. 


CHAPTER  X. 
Military  Hygiene. 

MUCH  disease  and  suffering  may  be  pre- 
vented, and  many  lives  saved,  by  a  careful 
observance  of  hygienic  regulations.  There  is 
no  question  whatever  that  immense  numbers 
of  soldiers  everywhere  fall  victims  to  their 
recklessness  and  the  indulgence  of  their  ap- 
petites and  passions.  We  would  not  advo- 
cate too  much  restraint ;  men  are  but  men 
everywhere,  and  soldiers  form  no  exception 
to  the  general  law.  They,  like  civilians,  must 
have  their  amusements  and  recreations.  The 
bow  cannot  last  long,  if  kept  too  constantly 
and  too  tightly  on  the  stretch.  Occasional 
relaxation  is  indispensable  to  health. 


140  A   MANUAL    OP 

Indolence,  however,  should  never  be  coun- 
tenanced in  any  army.  Its  demoralizing  effects, 
and  its  influence  upon  the  health  of  the  soldier, 
have  been  noticed  and  commented  upon  in  all 
ages. . "  The  efficacy,"  says  an  eminent  military 
surgeon,  in  speaking  on  the  subject,  "  of  due 
attention  to  the  occupation  of  the  mind  must 
never  be  lost  sight  of.  Many  illustrations  of 
its  powerful  influence,  whether  for  good  or 
evil,  whether  in  resisting  or  accelerating  the 
inroads  of  disease,  may  be  found  both  in  an- 
cient and  in  modern  times,  from  the  retreat 
of  the  ten  thousand  Greeks  under  Xenophon 
down  to  the  present  day.  It  may  be  observed 
thafrdisease  goes  hand  in  hand  with  indolence 
and  inactivity,  whether  of  body  or  of  mind ; 
and  that,  on  the  contrary,  where  the  minds 
of  soldiers  are  agreeably  occupied,  and  their 
bodies  energetically  employed,  as  in  the  at- 
tainment or  pursuit  of  victory,  disease  is 
kept  in  abeyance."  It  was  the  observation 
of  another  experienced  authority  in  military 
medical  affairs,  Mr.  Alcock,  that  "the  period 
of  the  smallest  loss  to  an  army  is  a  victorious 
and  vigorously  prosecuted  campaign,  with  fre- 
quent battles  and  much  marching;"  an  asser- 


MILITARY    SURGERY.  141 

tion  corroborative  of  the  facts,  long  since  so 
painfully  realized,  that  sickness,  however  in- 
duced, destroys  incomparably  more  soldiers 
than  the  sword  and  the  musket. 

No  intemperance,  either  in  eating  or  drink- 
ing, should  be  tolerated  in  an  army;  both  are 
demoralizing,  and  both  predispose  to,  if  not 
actually  provoke,  disease.  Alcoholic  liquors 
should  not  be  permitted  to  be  used  except  as 
medicine,  and  then  only  under  the  immediate 
direction  of  the  medical  officer.  The  ordinary 
drink  and  food  should  be  selected  with  special 
reference  to  their  healthful  properties.  The 
use  of  bad  water,  even  for  a  short  time,  is 
invariably  productive  of  mischief.  The  tea 
and  coffee  should  be  of  good  quality,  and  well 
prepared,  to  preserve  their  agreeable  flavor 
and  their  soothing  and  refreshing  effects. 
Lager  beer,  ale,  and  porter,  if  sound,  are 
both  nourishing  and  wholesome,  if  consumed 
.within  judicious  limits. 

The  practice  of  allowing  soldiers  spirituous 
liquors  as  a  portion  of  their  daily  rations  has, 
I  believe,  been  pretty  generally,  if  not  en- 
tirely, abandoned  in  the  European  service. 
Its  injurious  effects  upon  the  health  and  morals 
13 


142  A  MANUAL   OF 

of  troops  have  long  been  deprecated.  In  the 
British  army  in  India,  the  use  of  alcoholic 
liquors  was,  at  one  time,  universal,  on  the 
supposition  that  it  had  a  tendency  to  counter- 
act the  depressing  influences  of  a  tropical 
climate;  the  men  took  their  spirits  regularly 
before  breakfast,  and  not  unfrequently  several 
times  during  the  day,  especially  if  on  active 
duty ;  but  it  was  soon  found  that  it  produced 
quite  a  contrary  impression,  causing  instead 
of  preventing  debility,  and  affording  a  tempt- 
ation to  general  drunkenness,  which  was  fol- 
lowed by  insubordination  and  crime.  The 
result  was  that  the  government  abolished  the 
alcoholic  ration  system  altogether,  substituting 
coffee  and  tea,  which  are  now  regularly  served 
once,  and  often  twice  a  day. 

The  condition  of  the  13th  Regiment  of 
Light  Infantry,  stationed  at  Jellalabad,  dur- 
ing the  late  insurrection  in  India,  affords  a 
happy  illustration  of  the  salutary  effects  of 
abstinence  from  spirituous  liquors.  While  the 
siege  was  progressing,  the  men,  during  a 
period  of  five  months,  were  entirely  debarred 
from  drinking,  and  yet  their  health  and  cour- 
age were  most  excellent.  As  soon,  however, 


MILITARY   SURGERY.  143 

as  the  garrison  was  relieved,  and  they  began 
to  indulge  in  spirits,  many  of  them  in  a  short 
time  became  sick  and  riotous.  The  experi- 
ence of  Major-General  Wylie,  of  the  Bombay 
army,  was  precisely  similar.  When  the  sol- 
diers under  his  command  were  quartered  in 
districts  where  no  liquor  could  be  obtained, 
their  health,  discipline,  and  morals  were  all 
that  could  be  desired ;  whereas,  under  opposite 
circumstances,  insubordination  and  disease 
prevailed  to  a  frightful  extent. 

During  the  Crimean  war,  coffee  and  tea 
were  found  to  be  eminently  wholesome  and 
invigorating,  enabling  the  troops  to  sustain 
fatigue  and  to  resist  disease.  When  the  men 
were  in  the  trenches,  and  could  not  obtain 
their  usual  supplies  of  these  articles,  they 
became  languid,  and  suffered  from  dysentery 
and  diarrhoea.  To  produce  their  peculiar  sus- 
taining and  exhilarating  effects,  coffee  and  tea 
should  be  taken  hot  and  moderately  strong, 
with  sugar,  if  not  also  with  cream. 

Fresh  meats  are  always  preferable  to  salt, 
though  good  ham  and  smoked  beef  may  be 
taken  once  a  day  with  advantage  as  an  agree- 
able change.  Fresh  fish  are  always  accept- 


144  A   MANUAL    OF 

able.  Pickled  pork  and  beef  are  far  from 
being  good  articles  as  a  portion  of  the  daily 
rations.  The  frequent  use  of  fresh  vegetables 
is  indispensable  to  the  health  of  the  soldiery. 
Ripe  fruits  are  nearly  equally  so.  Without 
a  proper  admixture  of  this  kind,  dyspepsia, 
bowel  complaints,  and  scurvy  will,  sooner  or 
later,  inevitably  ensue ;  and  woe  to  the  man 
that  is  assailed  by  them !  The  acids  and 
other  properties  contained  in  these  substances 
are  indispensable  to  the  healthy  condition  of 
the  blood  and  the  solids,  and  the  importance 
of  such  a  diet  cannot  be  too  deeply  or  too 
frequently  impressed  upon  the  attention  of 
every  commissariat.  Potatoes,  rice,  hominy, 
beans,  peas,  beets,  spinach,  lettuce,  asparagus, 
radishes,  horse-radish,  water -cresses,  dried 
peaches  and  apples,  and  the  different  kinds 
of  fruits  as  they  come  into  season,  should  be 
constantly  on  hand.  Soups,  both  animal  and 
vegetable,  are  generally  grateful  to  the  palate, 
as  well  as  useful  to  the  system,  and  should  be 
used  whenever  the  occasion  is  favorable  for 
their  preparation. 

Eggs,  butter,  milk,  and  butter-milk  should 
be  freely  indulged  in  ^henever  they  can  be 


MILITARY   SURGERY.  145 

procured.  Serious  disease  is  often  engen- 
dered by  bad  bread  and  biscuit,  and  it  should 
therefore  be  made  a  part  of  the  duty  of  every 
medical  officer  to  see  that  no  articles  of  this 
kind  are  brought  into  camp. 

When  in  the  camp  or  barracks,  the  soldier 
should  take  his  meals  with  the  same  regular- 
ity as  the  ordinary  citizen  at  his  home.  Ne- 
glect of  this  precaution  must  necessarily  lead 
to  great  bodily  inconvenience,  and,  if  long 
persisted  in,  may  ultimately  lead  to  serious 
disease,  especially  dyspepsia  and  other  disor- 
ders of  the  digestive  apparatus.  He  should 
not  disregard  regularity  even  with  respect  to 
his  alvine  evacuations;  for  there  are  few 
things  more  conducive  to  the  preservation  of 
the  health. 

The  soldier's  dress  should  be  in  strict  con- 
formity with  the  season  of  the  year  and  the 
vicissitudes  of  the  weather.  He  should,  at 
no  time,  be  either  too  hot  or  too  cold,  but 
always  comfortable,  changing  his  apparel  with 
the  alterations  of  the  temperature.  Flannel 
should  be  worn  next  the  surface  both  winter 
and  summer.  The  shoes  must  be  thick  and 
warm,  with  broad  soles ;  and  woolen  stockings 
13* 


146  A   MANUAL    OF 

will  be  more  comfortable,  especially  when  the 
troops  are  marching,  than  cotton.  A  thin 
woolen  cap-cover,  found  so  useful  in  India, 
will  protect  the  neck  from  the  hot  sun,  and 
an  oil-silk  cap-cover,  from  the  rain.  In  very 
wet  weather  the  shoulders  might  be  defended 
with  a  cape  of  oil-cloth. 

Frequent  ablutions  will  largely  contribute 
to  the  comfort  of  the  soldier  and  the  preser- 
vation of  his  health.  They  should  be  per- 
formed at  least  once  a  day,  the  best  time 
being  late  in  the  afternoon  or  in  the  evening 
just  before  retiring.  The  feet,  in  particular, 
should  be  often  washed,  especially  in  march- 
ing, for  reasons  which  need  not  be  dwelt 
upon  here.  The  under-shirt  should  be  changed 
every  night,  and  frequently  washed,  to  pro- 
mote the  healthy  state  of  the  skin. 

Exposure  to  the  hot  sun,  to  cold  and  wet, 
must  alike  be  avoided.  Sojourning  in  mala- 
rious regions  will  be  certain  to  be  punished  by 
an  attack  of  neuralgia  or  intermittent  fever. 

All  offals  should  be  promptly  removed  from 
the  camp,  and  carried  to  a  distance  of  several 
miles,  or  be  well  buried. 

The  privies  should  be  in  the  most  favora- 


MILITARY   SURGERY.  147 

ble  location  as  it  respects  ventilation,  and  be 
closed  at  least  every  three  or  four  days ;  or, 
what  is  worthy  of  consideration,  every  man 
should  be  compelled  to  bury  his  alvine  excre- 
tions, as  was  the  custom,  in  time  of  war,  among 
the  ancient  Hebrews,  each  man  being  obliged 
to  carry  a  paddle  for  that  purpose.  The  ema- 
nations from  these  sources  cannot  receive  too 
much  attention,  especially  when  large  masses 
of  men  are  crowded  together,  as  they  are  then 
extremely  prone  to  induce  disease. 

Finally,  the  medical  officer  should  make  it 
his  special  duty  to  see  that  every  recruit  is 
vaccinated,  or,  if  the  operation  was  performed 
prior  to  his  enlistment,  at  a  distant  period, 
matter  should  again  be  inserted,  experience 
having  shown  that  the  effects  of  the  virus  are, 
in  time,  in  many  instances,  totally  eradicated 
from  the  system.  In  most  of  the  European 
armies  revaccination  is  extensively  practiced ; 
and  it  is  asserted  by  Stromeyer  that  during 
the  Schleswig-Holstein  war,  on  an  average, 
38  operations  out  of  1000  were  successful. 

It  is  impossible  to  bestow  too  much  care 
and  attention  upon  the  selection  of  the  camp 
ground  and  the  arrangement  of  the  tents,  as 


148  A   MANUAL    OF 

a  vast  deal  of  the  comfort  and  health  of  the 
soldiers  must  necessarily  depend  upon  them. 
The  following  judicious  remarks  upon  this 
subject  are  from  the  pen  of  an  eminent  mili- 
tary surgeon,  the  late  Dr.  Ballingall,  who 
served  in  various  campaigns,  and  who  was  for 
many  years,  as  stated  elsewhere,  Professor  of 
Military  Surgery  in  the  University  of  Edin- 
burgh. 

"A  camp,"  says  Ballingall,  "is  most  ad- 
vantageously situated  on  a  gentle  declivity, 
on  a  dry  soil,  and  in  the  vicinity  of  a  run- 
ning stream.  In  order  to  ascertain  the  state 
of  the  ground  it  may  sometimes  be  necessary 
to  dig  into  it  to  some  extent ;  for,  although 
apparently  dry  on  the  surface,  it  may  be 
found  sufficiently  wet  at  the  depth  of  a  few 
feet ;  and  if  so,  ought,  if  possible,  to  be 
changed,  particularly  if  an  encampment  is 
to  be  stationary.  A  camp  should  never  be 
formed  on  ground  recently  occupied,  nor  on 
a  field  of  battle  where  much  carnage  has  re- 
cently occurred.  Many  favorable  spots  are 
to  be  found  on  the  banks  of  rivers,  which, 
perhaps,  upon  the  whole,  afford  the  most 
eligible  sites.  We  must  yet  bear  in  mind 


MILITARY   SURGERY.  149 

| 

that,  when  the  banks  of  the  rivers  are  low, 
or  the  country  subject  to  periodical  rains  or 
sudden  inundations  from  the  melting  of  snow 
on  contiguous  mountains,  there  may  be  a  very 
serious  danger  from  this  cause.  Against  the 
danger  of  such  a  position,  we  are  cautioned 
in  Mezerey's  4  Me'decine  d'Arm^e,'  which 
states  a  case  in  which  the  Austrian  army 
lost  500  men  and  200  horse  from  a  sudden 
inundation  of  this  kind." 

When  damp  ground  or  a  low  situation  is 
unavoidable,  it  should  be  abandoned  as  soon 
as  possible  for  a  better,  and,  in  the  mean  time, 
the  greatest  care  should  be  taken  to  protect 
the  soldiers  from  damp  and  wet  with  straw  or 
other  suitable  means.  , 

An  army  has  been  known  to  suffer  severely 
from  disease  contracted  in  a  malarious  region. 
Against  such  a  calamity  useful  information 
may  often  be  elicited  from  the  people  of  the 
neighborhood,  especially  physicians  conver- 
sant with  insalubrious  site^. 

When  an  army  is  obliged  to  remain  for  a 
long  time  stationary,  an  occasional  change  of 
camp  will  be  greatly  conducive  to  health, 
although  such  change  should  involve  a  good 


150  A  MANUAL  OF 

deal  of  labor  and  temporary  inconvenience. 
A  camp  under  such  circumstances  should,  at 
all  events,  be  frequently  ventilated,  and  kept 
constantly  clean,  a.  pure  atmosphere  being  of 
paramount  importance  to  health  and  comfort. 
It  may  often  be  difficult  to  do  this,  but  it 
must,  nevertheless,  be  done;  the  welfare  of 
the  service  absolutely  demands  it,  and  no 
medical  officer  honestly  performs  his  duty 
unless  he  interests  himself  personally  in  these 
matters.  "  The  most  obvious  and  perfect 
way,"  says  Ballingall,  "  of  thoroughly  airing 
the  tents  is  by  shifting  them  occasionally,  and 
exposing  the  straw,  blankets,  and  soldier's 
clothing  to  the  open  air ;  the  necessity  of  fre- 
quently changing  the  straw,  and  enforcing 
cleanliness  in  camp  in  every  possible  way, 
are  circumstances  too  obvious  to  require  any 
effort  of  reasoning  to  enforce.  With  this 
view  the  slaughtering  of  cattle,  and  every- 
thing likely  to  create  noxious  or  putrid 
effluvia,  ought  to  be  conducted  without  the 
camp,  and  on  the  side  of  it  opposite  to  that 
from  which  the  wind  generally  blows." 

The  demoralizing  influence  of  a  camp  life 
is  well  known,  and  I  am  convinced  that  there 


MILITARY   SURGERY.  151 

is  nothing  so  well  calculated  to  counteract 
this  influence  as  rigid  discipline,  reasonable 
activity  of  mind  and  body,  strict  temperance, 
both  in  eating  and  drinking,  and  frequent 
religious  worship.  Every  regiment  should 
have  its  chaplains,  not  less  than  its  medical 
officers,  not  only  with  a  view  of  restraining 
vice  and  promoting  morality,  but  of  affording 
to  the  poor  soldier,  away  from  home  and 
friends,  in  the  hour  of  his  mortal  extremity, 
those  consolations  which  the  minister  of  the 
gospel  alone  knows  how  to  impart.  The 
mitigation  of  the  horrors  and  miseries  of 
war,  not  less  than  the  tendencies  of  the  age 
in  which  we  live,  absolutely  demand  such  a 
provision. 


CHAPTER  XL 
Disqualifying  Diseases. 

TROOPS,  whether  regulars  or  volunteers, 
should  include  no  men  that  are  not  perfectly 
qualified,  both  physically  and  mentally,  for 
the  hardships  of  the  public  service.  They 


152  A   MANUAL    OF 

should,  in  a  word,  be  perfectly  sound,  or, 
what  is  the  same  thing,  free  from  all  defects, 
congenital  or  acquired.  It  is  for  this  reason 
that  they  are  always  subjected  to  a  most 
thorough  examination  by  the  recruiting  or 
regimental  surgeon.  This  examination  is, 
as  a  general  rule,  a  great  deal  more  rigid  in 
the  regular  than  in  the  volunteer  service.  In 
the  former,  the  regulations  are  such  that,  if 
the  recruit  is  not  found  to  be  sound  after  he 
has  been  inspected  by  the  regular  army  sur- 
geon, the  expense  incident  to  his  enlistment 
and  transportation  falls  upon  the  medical 
officer  who  committed  the  oversight. 

An  examination  of  the  kind  here  men- 
tioned demands  both  time,  patience,  and 
skill.  In  order  to  make  it  thorough,  the 
candidate  must  be  completely  stripped,  so 
that  if  any  disease  or  defect  in  the  exterior 
of  the  body  exist  it  may  be  at  once  rendered 
apparent.  The  examination,  however,  must 
not  be  limited  to  the  exterior ;  it  must  em- 
brace also  the  interior.  The  disqualifying 
affections  may  be  arranged  according  to  the 
organs  and  regions  in  which  they  are  seated, 
under  separate  heads : — 


MILITARY   SURGERY.  153 

1.  The  eye  and  ear.  2.  The  brain,  as  the 
seat  of  intellect.  3.  The  lungs  and  heart. 
4.  The  stomach,  bowels,  anus,  liver,  and 
spleen.  5.  The  kidneys,  bladder,  and  ure- 
thra. 6.  The  testicles.  7.  The  exterior 
of  the  abdomen.  8.  The  limbs,  including 
the  joints. 

The  diseases  which  unfit  a  man  for  mili- 
tary service  are  defects  of  sight,  of  hearing, 
and  of  speech;  weakness  of  intellect;  paraly- 
sis; epilepsy;  hernia;  hydrocele;  varicocele; 
imperfect  development  or  absence  of  the 
testes ;  hemorrhoids,  anal  fistule,  and  fissure 
of  the  anus ;  unusual  protuberance  of  the 
abdomen ;  organic  lesion  of  the  internal 
organs ;  large  tumors ;  aneurism ;  varix  of 
the  extremities ;  ulcers,  or  large  scars  indica- 
tive ,of  their  former  existence ;  bad  corns ; 
bunions ;  overlapping  toes  ;  flatfootedness  ; 
deformity  of  the  hands  and  fingers ;  contrac- 
tions from  burns  or  other  causes;  badly 
united  fractures ;  unreduced  dislocations ;  dis- 
eased joints ;  loss  of  the  incisor  and  canine 
teeth ;  serious  disfigurement  of  the  features ; 
spinal  curvature;  ill-formed  shoulders;  habits 
14 


154  A   MANUAL  OF 

of  intemperance;  diminutive  stature  or  exces- 
sive overgrowth. 

In  the  regular  army  no  man  is  enlisted 
under  the  age  of  eighteen  or  over  that  of 
forty-five.  In  the  volunteer  service,  similar 
regulations  obtain,  although  they  are  not  so 
rigidly  enforced. 

Recruiting  surgeons,  after  having  examined 
a  candidate  for  enlistment,  are  obliged  to  cer- 
tify, on  honor,  that  they  consider  him,  in 
their  opinion,  to  be  free  from  all  bodily  de- 
fects, and  mental  infirmity,  which  would,  in 
any  way,  disqualify  him  for  performing  the 
duties  of  a  soldier. 

When  men  become  disqualified  for  service, 
in  consequence  of  disease  or  accident,  a  sur- 
geon's certificate  is  also  required,  in  order  to 
aid  them  afterward  in  procuring  a  pension 
and  exemption  from  ordinary  military  duties. 
The  affections  which  may  justify  a  soldier  in 
applying  for  a  release  from  further  service 
are  organic  visceral  lesions,  deafness,  blind- 
ness, mental  imbecility,  lameness,  large  her- 
nise,  and  such  mutilations  as  interfere  with 
the  proper  handling  of  the  sword  and  musket. 


MILITARY   SURGERY.  155 

CHAPTER  XII. 
Feigned    Diseases, 

SOLDIERS,  influenced  by  a  desire  to  quit 
the  service,  to  revisit  their  homes,  or  evade 
active  duty,  will  not  hesitate,  at  times,  to 
play  the  part  of  impostors,  feigning  diseases, 
or  even  inflicting  upon  themselves  more  or  less 
serious  injuries,  with  the  hope  of  accomplish- 
ing their  designs.  This  deception,  technically 
called  malingering,  would  be  of  comparatively 
little  consequence  if  it  were  always,  or  even 
generally,  confined  to  a  few  members  of  a 
regiment;  but  when  it  is  remembered  that  it 
is  liable  to  become  epidemic,  spreading  from 
individual  to  individual,  it  assumes  a  deep  im- 
portance, well  calculated  to  arouse  the  atten- 
tion both  of  the  medical  officer  and  of  the 
military  commander.  Its  effects,  then,  be- 
come eminently  demoralizing  to  the  ser- 
vice, which,  if  proper  care  be  not  employed 
to  detect  and  punish  it,  might  seriously  suffer, 
especially  when  such  an  outbreak  occurs  on 


156  A   MANUAL   OP 

the  eve  of  a  battle.  Great  ingenuity  is  often 
displayed  by  malingerers,  requiring  no  little 
vigilance  and  skill  on  the  part  of  the  surgeon 
for  its  successful  exposure,  and  yet  it  is  not 
less  necessary  for  his  own  credit  than  for  the 
honor  of  the  service  that  he  should  not  per- 
mit himself  to  be  deceived. 

The  number  of  diseases,  imitated  by  this 
class  of  dissemblers,  is  surprisingly  great,  and 
there  is  also  quite  a  list  of  self-inflicted  inju- 
ries. Among  the  former  are  various  mental 
diseases,  as  mania  and  imbecility ;  deafness ; 
arnaurosis ;  epilepsy ;  paralysis  ;  haemateme- 
sis ;  haemoptysis  ;  gastritis ;  dysentery  and 
diarrhoea ;  affections  of  the  heart ;  rheuma- 
tism ;  lumbago ;  wry-neck ;  contractions  of 
the  joints ;  incontinence  of  urine ;  bloody 
urine ;  and  stone  in  the  bladder :  among  the 
latter  ophthalmia,  opacity  of  the  cornea, 
oedema  of  the  limbs,  wounds,  and  amputa- 
tions of  the  fingers. 

Space  will  not  permit  me  to  enter  into  any 
details  respecting  this  important  subject.  I 
shall,  therefore,  content  myself  with  a  pre- 
sentation of  such  facts  as  may  be  supposed  to 
be  of  special  practical  interest. 


MILITARY   SURGERY.  157 

First  of  all,  the  medical  officer  should  weigh 
well  in  his  own  mind  the  nature  of  the  disease 
for  which  a  soldier  applies  for  a  certificate  of 
discharge,  or  inability  to  perform  duty.  If 
the  case  is  one  of  recent  standing,  it  will  be 
well  not  to  come  to  too  hasty  a  conclusion  as 
to  its  diagnosis ;  it  should  be  examined  and 
re-examined  before  any  definite  opinion  is 
given.  Day  by  day  new  facts  may  be  devel- 
oped, revealing  the  true  character  of  the  affec- 
tion. If  the  patient  is  really  sick,  or  affected 
with  some  serious  chronic  disorder,  his  general 
appearance  will  hardly  fail  to  afford  some  evi- 
dence of  its  existence.  The  pallor  of  the 
countenance,  the  functional  disturbance  of 
the  suffering  organ,  the  bodily  prostration, 
the  want  of  appetite,  and  the  gradual  emacia- 
tion will  almost  unerringly  point  to  the  nature 
and  seat  of  the  disease.  When,  on  the  other 
hand,  the  malady  is  simulated,  all,  or  nearly 
all,  the  usual  phenomena  of  disease  will  be 
absent.  Imposters,  moreover,  are  generally 
very  zealous  in  talking  about  their  disorders, 
or  in  obtruding  them  upon  the  notice  of 
their  surgeons,  whereas  those  who  are  really 
sick  and  suffering  make  comparatively  little 
14* 


158  A   MANUAL   OP 

complaint.  A  malingerer  may  often  be  de- 
tected by  carefully  watching  his  movements, 
coming  suddenly  upon  him  when  he  is  asleep 
or  when  his  attention  is  directed  to  some  one 
else,  tickling  his  foot  when  he  feigns  paraly- 
sis, or  pricking  his  back  when  he  pretends  to 
be  laboring  under  lumbago.  Sometimes  a 
determined  threat  will  promptly  restore  him 
to  a  sense  of  his  duty,  as  the  application  of 
the  actual  cautery  in  incontinence  of  urine, 
rheumatism  of  the  joints,  or  mental  imbecility. 
Now  and  then  the  exhibition,  in  rapidly  re- 
peated doses,  of  a  nauseous  draught,  answers 
the  purpose.  Whatever  expedients  be  em- 
ployed, the  surgeon  cannot  exercise  too  much 
address,  otherwise  he  will  be  almost  sure  to 
be  baffled. 

Mental  alienation,  or  mania,  unless  the 
result  of  inebriation  and  of  acute  disease, 
generally  comes  on  gradually,  being  preceded 
by  a  marked  change  in  the  moral  character  of 
the  individual,  loss  of  appetite  and  sleep,  and 
other  evidences  of  general  disorder. 

Genuine  deafness  is  also  gradual  in  its 
approaches,  and,  when  fully  established,  is 
invariably  attended  by  a  peculiar  listless  state 


MILITARY   SURGERY.  159 

of  the  countenance  with  more  or  less  change 
of  the  voice.  Before  a  final  decision  is  given, 
a  careful  inspection  of  the  ears  should  be 
made,  to  ascertain  whether  there  is  any  ob- 
struction or  appearance  of  matter.  The  un- 
expected discharge  of  a  pistol,  in  a  case  of 
feigned  deafness,  might  suddenly  decide  the 
diagnosis. 

Amaurosis  may  be  simulated  by  the  inter- 
nal use  of  belladonna,  or  by  the  direct  appli- 
cation of  this  article  to  the  eye,  causing 
dilatation  and  immobility  of  the  pupil.  These 
effects  are  often  accompanied  by  unnatural 
vascularity  of  the  conjunctiva,  and  they  gen- 
erally disappear  spontaneously  in  a  few  days. 
In  genuine  amaurosis,  too,  there  is  always  a 
dilated  condition  of  the  vessels  of  the  eye. 

Feigned  epilepsy  differs  from  the  real  in 
the  absence  of  lividity  of  the  countenance, 
the  want  of  froth  at  the  mouth,  and  the 
partial  character  of  the  convulsions.  The 
pupil  does  not  contract  as  in  the  genuine 
disease,  the  general  sensibility  is  unimpaired, 
the  tongue  is  not  injured,  the  nails  are  not 
discolored,  the  hand,  if  opened,  is  again  firmly 
shut,  and  the  individual  often  watches  with 


160  A  MANUAL   OF 

his  eye  the  impression  the  attack  is  making 
upon  the  by-standers.  The  application  of  a 
heated  case-knife,  or  of  a  cloth  wrung  out  of 
hot  water,  often  speedily  reveals  the  imposi- 
tion. 

Paralysis  is  frequently  imitated,  but  is 
generally  easily  detected,  simply  by  watching 
the  patient,  tickling  his  feet  when  he  is  asleep, 
or  threatening  him  with  the  hot  iron.  The 
disease,  when  it  attacks  the  lower  extremity, 
is  nearly  always  caused  by  apoplexy,  and  is 
then  generally  associated  with  mental  weak- 
ness and  difficulty  of  articulation.  Partial 
paralysis  of  the  upper  extremity  is  frequently 
induced  by  lying  upon  the  arm,  by  suppres- 
sion of  the  cutaneous  perspiration,  and  disease 
of  the  spinal  cord. 

Hsematemesis  may  be  simulated  by  swal- 
lowing blood,  or  an  infusion  of  logwood,  and 
ejecting  the  fluid  afterward  by  vomiting.  It 
should  be  recollected  that  the  real  disease  is 
almost  invariably  connected  with  serious  or- 
ganic lesion,  as  ulceration  of  the  stomach, 
induration  and  enlargement  of  the  liver,  or 
visceral  obstruction,  and  that  the  patient, 
consequently,  will  exhibit  all  the  character- 
istics of  a  sick  person. 


MILITARY    SURGERY.  161 

Soldiers  sometimes  counterfeit  haemoptysis 
by  cutting  the  gums,  or  chewing  substances 
impregnated  with  coloring  matter.  A  case  is 
related  by  Guthrie,  in  which  a  man,  for  this 
purpose,  swallowed  a  piece  of  cork  full  of 
pins.  The  immediate  effect  was  haemoptysis, 
and  the  remote  one  death  by  wounding  the 
carotid  artery. 

Gastritis  may  be  simulated  by  spontaneous 
vomiting,  a  faculty  possessed  by  some  per- 
sons, and  by  pretended  pain  in  the  epigastric 
region.  The  attack  in  general  speedily  yields 
to  a  large  sinapism  and  a  brisk  emetic. 

Dysentery  and  diarrhoea  are  occasionally 
feigned  by  exciting,  artificially,  irritation  of 
the  rectum,  by  mixing  blood  with  the  alvine 
evacuations,  or  by  borrowing  the  discharges 
of  persons  actually  affected  with  these  dis- 
eases. In  genuine  dysentery  and  diarrhoea 
there  are  always  well-marked  constitutional 
phenomena,  which  are  of  course  absent  in  the 
spurious.  Careful  watching  of  the  patient 
and  compelling  him  to  use  a  close  stool  will 
soon  remove  any  doubt  that  may  exist  respect- 
ing the  nature  of  the  case. 

Disease  of  the  heart,  in  the  form  of  palpi- 


162  A   MANUAL   OF 

tation,  may,  it  is  said,  be  produced  by  the  use 
of  hellebore.  Mr.  Hutchinson,  of  England, 
refers  to  an  epidemic  of  this  kind  among  the 
members  of  the  Marine  Artillery.  Organic 
cardiac  disease  could  easily  be  detected  with 
the  stethoscope. 

Rheumatism  being  a  very  common  disease 
among  soldiers,  is  often  counterfeited;  but 
the  cheat  is  of  easy  detection  when  it  is  re- 
collected that  the  real  affection,  especially 
the  acute  form,  is  attended  with  more  or  less 
swelling  and  constitutional  disturbance. 

When  lumbago  is  made  the  subject  of  de- 
ception, the  attack  seldom  long  withstands 
the  application  of  rash  remedies,  or  the 
threatened  use,  if  speedy  relief  do  not  arise, 
of  the  hot  iron. 

Contraction  of  the  joints,  a  not  unfrequent 
source  of  imposition,  is  easily  detected  by  the 
use  of  anaesthetics,  or  simply  by  pricking  the 
parts  suddenly  with  a  needle  when  the  pa- 
tient is  off  his  guard. 

When  wry-neck  is  simulated,  both  the 
sterno-cleido-mastoid  muscles  are  rendered 
rigid  by  the  effort  at  deception ;  whereas  in 


MILITARY   SURGERY.  163 

the  real  disease  the  contraction  is  confined  to 
one  side. 

Incontinence  of  urine,  bloody  urine,  and 
stone  in  the  bladder  have  all  been  simulated 
by  designing  soldiers.  The  former  is  said  to 
be  at  times  epidemic,  and  then  its  detection 
is  of  course  easy,  as  the  ordinary  disease 
never  assumes  such  a  character.  Harsh  re- 
medies are  the  best  means  of  relief.  Ballin- 
gall  states  that  fictitious  cases  of  incontinence 
have  been  successfully  treated  by  the  cold 
bath,  by  prescribing  a  few  lashes  on  the  loins 
with  the  avowed  object  of  strengthening  the 
parts.  In  the  Austrian  army  the  impostor  is 
obliged  to  do  duty  with  a  urinal. 

Bloody  urine  has  been  provoked  by  inject- 
ing blood  into  the  bladder,  and  by  scarifying 
the  urethra. 

Calculus  is  almost  unknown  among  sol- 
diers ;  it  is  sometimes  attempted  to  be  coun- 
terfeited by  scraping  the  walls  and  throwing 
the  lime  into  the  urinal.  When  stone  actually 
exists,  the  sound  will  generally  promptly 
detect  it. 

Self-inflicted  injuries  of  various  kinds  are 
resorted  to  for  the  purposes  of  deception. 


164  A   MANUAL   OP 

Thus  malingerers  often  provoke  inflammation 
of  the  eye  and  temporary  opacity  of  the  cor- 
nea by  means  of  corrosive  sublimate,  lime, 
tobacco,  nitrate  of  silver,  and  other  irritants. 
A  great  number  of  men  have  been  known  to 
suffer  from  this  cause  at  the  same  time,  as  if 
the  disease  were  an  epidemic.  Ulcers  of  the 
legs  are  produced  by  pricking  the  skin  with 
pins  or  needles,  frictions  with  sand,  or  caustic 
applications.  (Edema  of  the  limbs  may  be 
excited  by  tight  ligatures ;  disease  of  the 
scrotum  and  testicle,  by  inflation  of  the  parts 
with  air.  All  such  tricks  are  usually  readily 
detected  by  the  medical  officer  and  his  assist- 
ants. 

Self-mutilation  sometimes  amounts  to  the 
destruction  of  an  eye,  an  entire  finger,  or 
even  the  greater  portion  of  the  hand.  Occa- 
sionally it  is  limited  to  slight  wounds,  and  the 
imposition  may  then  be  practiced  on  an  ex- 
tensive scale,  as  was  the  case  in  the  French 
army  at  the  battles  of  Lutzen  and  Bautzen, 
in  which  nearly  3000  soldiers  were  slightly 
injured  in  the  hands,  causing  the  belief  that 
the  wounds  had  been  voluntarily  inflicted. 


MILITARY   SURGERY.  165 

CHAPTER  XIII. 
Medical,  Surgical,  and  Dietetic  Formulae, 

UNDER  this  head  I  propose  to  notice  such 
formulae,  or  medical,  surgical,  and  dietetic 
preparations,  as  have  been  found  serviceable 
in  my  own  practice  or  in  the  practice  of 
others. 

1. — General  Remedies. 
Among  the  more  simple  purgatives  may  be 
mentioned  the  following :  all  drastic  articles 
should,  if  possible,  be  excluded  from  the  pre- 
scriptions of  the  military  surgeon  : — 
1^. — Massae  ex  Hydrargy.  gr.  x ; 

Pulv.  Ipecac,  gr.  i. 
M.  ft.  pil.  ii. 

A  mild  laxative  in  dyspepsia  and  disorders  of 
the  stomach  and  liver. 
~fy. — Extr.  Colocynth.  c; 
Massae  ex  Hydrargy. 
Pulv.  Ehei.  v.  Jalapae,  aa  gr.  x; 
Ant.  et  Potassae  Tart.  gr.  yg. 
M.  ft.  pil.  v. 

15 


166  A  MANUAL   OF 

An  active,  antibilious  purgative,  from  three 
to  five  being  an  ordinary  dose.  Calomel  may 
be  substituted  for  the  blue  mass,  if  there  is 
much  disorder  of  the  liver  and  secretions. 

The  safest  emetics  are  ipecacuanha,  infu- 
sion of  eupatorium,  perfoliatum,  and  mustard 
and  common  salt,  an  even  tablespoonful  of 
each  to  half  a  pint  of  tepid  water,  one-half 
to  be  taken  at  once,  the  remainder,  if  neces- 
sary, in  fifteen  minutes.  Sulphate  of  copper 
or  zinc  will  afford  the  most  prompt  emetic 
effect  in  case  of  great  urgency,  as  in  poisoning. 

The  following  formula  will  be  found  very 
serviceable  in  the  earlier  stages  of  most  in- 
flammatory affections,  especially  the  cutane- 
ous, articular,  and  traumatic,  unaccompanied 
by  disease  of  the  alimentary  canal : — 

1^. — Ant.  et  Potass.  Tart.  gr.  iss ; 
Magnesias  Sulph.  gi ; 
Morphine  Sulph.  gr.  ss ; 
Sacch.  Albi.  5ii  5 
Aquae  Destil.  Svi.     M. 
This  is  the  antimonial  and  saline  mixture 
of  which  repeated  mention  occurs  in  the  pre- 
ceding pages,  and  which  I  am  in  the  daily 
habit  of  prescribing  in  my  surgical  as  well  as 


MILITARY   SURGERY.  16t 

medical  practice.  It  may  be  rendered  de- 
pressant by  the  addition  to  each  dose — which 
is  half  an  ounce,  repeated  every  two  or  three 
hours — of  from  three  to  eight  drops  of  the 
tincture  of  veratrum  viride;  anodyne,  or 
diaphoretic,  by  laudanum,  or  morphia ;  anti- 
periodic,  by  quinine;  anti-gonorrhoeal,  by 
copaiba,  gum-arabic  being  used,  in  the  latter 
case,  as  one  of  the  ingredients ;  and  anti- 
rheumatic,  by  colchicum.  If  quinine  be  used, 
the  addition  of  aromatic  sulphuric  acid  will 
be  required,  which  is  also  an  excellent  solvent 
of  the  salts. 

1$*. — Vini  Colchici  Sem.  51 ; 

Morphias  Sulph.  gr.  ss ; 

Potassae  Carbon,  gr.  x ; 

Aquae  Destil.  gss.     M. 
In  rheumatic  and  gouty  affections,  taken  at 
bedtime,  and   followed   by  a  mild   aperient 
next  morning. 

The  following  will  be  found  to  be  pleasant 
and  efficient  diaphoretics: — 
^. — Spirit.  Mindereri,  §iv ; 
Sp.  JBther.  Nitrici.  5ii ; 
Morphias  Acet.  gr.  i.     M.  S. 
Tablespoonful  every  two  or  three  hours*     If 
there  be  much  heat  of  surface,  we  may  add 


168  A  MANUAL  OP 

to  each  dose  the  eighth,  twelfth,  or  fifteenth 
of  a  grain  of  tartar  emetic. 
1^. — Potassae  Carbon.  5i? 

Morphiae  Sulph.  gr.  i ; 

Sacch.  Albi.  %ii ; 

Sue.  Limonis  recent.  %ii ; 

Aquae  Menth.  v.  Destil.  giiiss ; 

Sp.  JEther.  Nitrici.  gss.     M.  S. 
Tablespoonful  every  hour  or  two. 

The  effervescing  draught,  so  valuable  in 
irritability  of  the  stomach,  is  composed  as 
follows : — 

1^. — Sue.  Limonis  recent.  5ji  ? 

Sacch.  Albi.  5jigs  ? 

Aquae  Destil.  gji.     M. 

1^. — Potassae  Carbon.  Ji  ? 

Aquae  Destil.  Sji.     M. 

Put  two  tablespoonsful  of  the  lemonade  with 
one  of  the  alkaline  solution,  and  let  the  mix- 
ture be  drunk  while  effervescing,  repeating 
the  dose  at  pleasure.  • 

As  antiperiodics  quinine  and  arsenic  are 
the  main  reliance  of  the  modern  practitioner. 
The  former  may  be  given  by  itself,  in  pill  or 
solution,  in  doses  varying  from  two  to  ten 
grains,  according  to  the  urgency  of  the  case 


MILITARY   SURGERY.  169 

or  the  state  of  the  system.  My  usual  dose  is 
ten  grains  every  eight,  ten,  or  twelve  hours, 
until  the  paroxysm  is  arrested.  If  the 
symptoms  are  unusually  violent,  we  need  not 
hesitate  to  administer  fifteen  or  even  twenty 
grains  at  a  dose,  being  of  course  careful  to 
watch  the  effects,  which  will  generally  be 
more  pleasant  if  a  little  morphia  be  combined 
with  the  quinine. 

In  chronic,  or  frequently-recurring  inter- 
mittent and  neuralgic  affections,  arsenic 
forms  a  valuable,  and;  indeed,  in  many  cases, 
an  indispensable  addition ;  also  iron,  if  there 
be  evidences  of  anaemia.  I  prefer  myself 
the  arsenious  acid  to  Fowler's  solution,  con- 
vinced that  it  is  much  more  efficacious  and 
at  the  same  time  less  apt  to  cause  nausea  and 
anasarca.  The  following  formula  will  be 
found  advantageous  : —  ,* 

1^. — Acid.  Arseniosi,  gr.  iss  ; 

Quiniae  Sulph. 

Ferri  Sulph.  aa  3i ; 

Morphias  Sulph.  gr.  i ; 

Extr.  Nucis  Vomicae,  9i. 
M.  ft.  pil.  xxx. 

S.  One  every  five,  six,  or  eight  hours. 
15* 


ItO  A  MANUAL   OF 

Quinine  is  also  one  of  the  best  tonics,  and 
it  may  always  be  beneficially  combined  with 
other  articles,  as  iron,  gentian,  quassia,  nux 
vomica,  and  capsicum.  The  fluid  extracts 
and  aromatic  tinctures  of  bark  and  gentian 
will  also  be  found  useful.  One  of  the  best 
chalybeate  preparations  is  the  tincture  of  the 
chloride  of  iron,  in  doses  of  from  twenty  to 
twenty-five  drops  three  or  four  times  daily. 

Expectorants  constitute  a  large  class  of 
remedial  agents,  but  they  nearly  all  derive 
their  active  principles  from  the  admixture  of 
tartar  emetic,  ipecacuanha,  or  squills.  They 
may  generally  be  usefully  combined  with 
potassa  and  anodynes,  being  rendered  pala- 
table by  syrup  or  sugar. 

Nurses  should  be  familiar  with  the  manner 
of  administering  enemata  or  injections,  as  fre- 
quent occasions  arise  for  their  employment. 
They  may  be  cathartic,  as  when  they  are  de- 
signed to  empty  the  lower  bowel,  or  to  pro- 
mote the  action  of  other  remedies;  stimulant, 
as  in  case  of  excessive  exhaustion ;  nutritive, 
as  when  food  cannot  be  taken  by  the  mouth ; 
anodyne,  when  it  is  wished  to  allay  pain  and 
induce  sleep. 


MILITARY   SURGERY.  171 

A  cathartic  effect  may  readily  be  induced 
by  an  injection  of  a  pint  and  a  half  of  cold 
water,  or  water  in  which  a  little  ground  mus- 
tard or  common  salt  has  been  stirred,  a  mix- 
ture of  warm  water  and  castor  oil ;  or  an 
infusion  of  senna,  or  senna  and  Epsom  salts. 
Turpentine  is  particularly  indicated  when  the 
bowels  are  distended  with  flatus. 

Stimulating  injections  may  be  made  of 
brandy,  alcohol,  mustard,  salt,  or  spirits  of 
camphor  or  turpentine,  mixed  with  more  or 
less  water ;  and  they  are  often  extremely  ser- 
viceable in  promoting  reaction. 

Nutritive  enemata  may  be  necessary  in  the 
low  stages  of  fever,  and  in  gunshot  and  other 
injuries  attended  with  lesion  of  the  gullet. 
The  best  ingredients  are  essence  of  beef, 
strong  beef-tea,  brandy,  or  brandy  and  milk, 
introduced  in  small  quantity  so  as  not  to 
oppress  and  irritate  the  rectum. 

Anodyne  injections  may  consist  of  lauda- 
num, black  drop,  morphia,  hyoscyamus,  or 
belladonna,  either  alone,  or  variously  com- 
bined, and  administered  with  about  two  ounces 
of  tepid  water,  or  some  demulcent  fluid. 

The  best  syringe  now  in  use  is  the  gutta- 


172  A   MANUAL   OP 

percha,  which  is  not  liable  to  be  deranged, 
and  which  has  the  additional  advantage  of 
durability.  It  should  be  of  various  capacities, 
from  eight  to  sixteen  ounces,  according  to  the 
intention  to  be  fulfilled  by  it.  The  nozzle 
must  be  well  oiled  previously  to  its  introduc- 
tion, and  care  taken  that  no  air  be  pushed 
into  the  bowel. 

2. —  Topical  Remedies. 

1^. — Tinct.  lodinae, 

Sp.  Vini  Rectific.  aa  5j.     M. 
To  be  applied  with  a  large  camel-hair  pencil, 
or  cloth  mop.     I  hardly  ever  use  the  pure 
tincture  of  iodine  for  local  purposes. 
Tfy. — Plumbi  Subacet.  Sj  ; 
Pulv.  Opii,  5j.     M. 

To  be  put  in  half  a  gallon  of  hot  water, 
and  the  solution  to  be  used  warm  or  cold,  as 
may  be  deemed  best.  Laudanum  may  be 
substituted  for  the  opium. 

1^. — Pulv.  Ammonias  Hydrochlor.  gj  ; 
"     Potassae  Nitrat.  3\j  5 
"     Opii,  3j.    M. 
To  be  used  as  the  preceding,  being  particu- 


MILITARY   SURGERY.  173 

larly  valuable,  in  inflammation  of  the  joints, 
on  unbroken  surfaces. 

The  warm  water- dressing  consists  of  warm 
water,  simple  or  medicated  with  laudanum, 
acetate  of  lead,  or  any  other  ingredient  that 
may  be  desired,  applied  upon  flannel  or  mus- 
lin cloths,  properly  folded,  and  covered  with 
oiled  silk,  to  confine  heat  and  moisture. 

The  cold  water-dressing  is  composed  of 
cold  water,  also  simple  or  medicated,  applied 
with  cloths,  the  parts  being  constantly  ex- 
posed to  the  air  to  promote  evaporation.  The 
cloths  are  wet  whenever  they  become  heated 
or  dryish,  the  water  being  pressed  upon  them 
from  a  sponge. 

Water-dressings,  if  long  continued,  will 
occasionally  cause  irritation,  itching,  and 
pustulation  of  the  skin,  rendering  it  neces- 
sary to  replace  them  with  cataplasms,  or 
other  soothing  remedies. 

Among  poultices  decidedly  the  best,  for 
ordinary  purposes,  are  the  flaxseed  and 
slippery  elm.  The  former  is  made  by  mixing 
a  suitable  quantity  of  linseed  meal  with  hot, 
or,  what  is  still  better,  boiling  water,  and 
rapidly  stirring  it  into  a  thick  mush-like  con- 


174  A   MANUAL   OF 

sistence.  The  mixture  is  then  spread  upon 
a  fold  of  cloth,  in  a  layer  a  third  of  an  inch 
thick,  when  it  is  covered  with  bobinet  or 
gauze  to  prevent  it  from  adhering  to  the 
parts.  A  piece  of  oiled  silk,  larger  than 
the  poultices,  is  placed  upon  its  outer  sur- 
face, to  retain  heat  and  moisture. 

The  elm,  and,  in  fact,  all  other  cataplasms, 
are  prepared  and  used  upon  the  same  princi- 
ples as  the  linseed.  Like  water-dressings, 
poultices  may  be  simple  or  medicated,  accord- 
ing to  the  object  proposed.  They  should  be 
changed  at  least  twice,  or,  in  warm  weather, 
even  three  or  four  times  in  the  twenty-four 
haurs. 

Adhesive  plaster  is  cut,  in  the  direction  of 
its  length,  into  strips  of  suitable  length  and 
breadth,  warmed  by  holding  the  back  against 
a  smooth  vessel,  as  a  pitcher  or  tin  case,  and 
applied  in  such  a  manner  as  to  bring  the  mid- 
dle of  each  piece  over  the  wound,  the  edges  of 
which  are,  meanwhile,  carefully  supported  by 
an  assistant.  A  suitable  space  is  left  between 
the  strips  for  drainage.  If  things  progress 
favorably,  substitution  need  not  be  made 
under  three  or  four  days.  If  the  wound  be 


MILITARY   SURGERY.  175 

large,  only  a  few  of  the  strips  are  taken  off 
at  a  time,  lest,  all  support  being  lost,  the 
edges  should  be  forcibly  separated. 

Before  the  soiled  dressings  are  removed, 
everything  intended  for  the  new  should  be 
prepared,  or  put  in  its  proper  place.  The 
strips  of  plaster  must  be  removed  with  great 
gentleness. 

If  the  injured  parts  are  covered  with  hair, 
the  surface  must  always  be  shaved  before  the 
application  of  the  dressings. 

Proper  material  for  sutures  should  always 
be  kept  on  hand,  ready  for  use.  The  silver 
wire  is  the  best,  as  it  is  less  irritating  than 
any  other.  Silk,  however,  answers  exceed- 
ingly well ;  the  thread  should  be  rather  thin, 
and  be  well  waxed.  Saddler's  silk  is  the  arti- 
cle used  for  the  ligation  of  large  arteries. 

Among  the  more  common  and  useful  un- 
guents for  dressing  wounds,  burns,  abraded 
surfaces,  or  fissures,  are  the  following : — 
Tfy. — Pulv.  Opii,  5ss ; 
Pulv.  Rhei,  3i ; 
Ung.  Cetacei,  §i.     M. 

To  these  ingredients  may  advantageously  be 
added,  in  many  cases  of  healing   sores,  or 


116  A   MANUAL  OF 

eruptions  requiring  a  mild  stimulus,  a  drachm 
of  the  ointment  of  the  nitrate  of  mercury,  a 
few  drops  of  nitric  acid,  two  drachms  of  oint- 
ment of  acetate  of  lead,  a  small  quantity  of 
myrrh,  or  of  balsam  of  Peru,  or  from  six  to 
eight  grains  of  sulphate  of  quinine. 
1^. — Ung.  Cetacei,  Si ; 

Bismuth.  Subnitr.  5y»  M. 
Extremely  soothing  and  valuable  in  super- 
ficial excoriations,  slight  burns,  and  eczema- 
tous  affections.  Turner's  cerate  may  be  em- 
ployed for  similar  purposes,  but  should  always 
be  considerably  diluted. 

The  best  disinfectants  are  the  chloride  of 
soda,  chloride  of  lime,  Labarraque's  solution, 
and  the  hypermanganate  of  potassa,  of  which 
an  abundant  supply  should  always  be  on  hand 
in  every  hospital,  free  use  of  it  being  made, 
by  sprinkling  and  otherwise,  upon  the  dress- 
ings, as  well  as  upon  the  bedding  and  the 
rooms. 

The  sponges  about  a  hospital  should  be  of 
the  softest  kind,  perfectly  clean,  and  always 
ready  for  use.  The  same  articles  should 
never  be  employed  upon  different  persons, 


MILITARY   SURGERY.  177 

especially  where  there  are  foul  or  specific 
sores,  as  contagion  might  thus  be  communi- 
cated by  direct  inoculation,  as  has,  for  exam- 
ple, so  often  happened  during  the  prevalence 
of  hospital  gangrene. 

3. — Dietetic  Preparations. 

The  diet  of  the  sick-room  has  slain  its 
thousands  and  tens  of  thousands.  Broths, 
and  slops,  and  jellies,  and  custards,  and  pti- 
sans are  usually  as  disgusting  as  they  are  per- 
nicious. Men  worn  out  by  disease  and  injury 
must  have  nutritious  and  concentrated  food. 
The  ordinary  preparations  for  the  sick  are,  in 
general,  not  only  not  nutritious,  but  insipid 
and  flatulent.  Nitrogenous  food  is  what  is 
needed,  even  if  the  quantity  taken  be  very 
small.  Animal  soups  are  among  the  most 
efficient  supporters  of  the  exhausted  system, 
and  every  medical  man  should  know  how  to 
give  directions  for  their  preparation.  The 
life  of  a  man  is  his  food.  Solid  articles  are 
of  course  withheld  in  acute  diseases,  in  their 
earlier  stages,  but  when  the  patient  begins  to 
convalesce  they  are  frequently  borne  with 
16 


178  A   MANUAL   OF 

impunity,  and  greatly  promote  recovery.  All 
animal  soups  should  be  made  of  lean  meat; 
and  their  nutritious  properties,  as  well  as 
their  flavor,  may  be  much  increased  by  the 
addition  of  some  vegetable  substance,  as  rice 
or  barley.  If  the  stomach  is  very  weak,  they 
may  be  diluted,  or  seasoned  with  pepper. 

Essence  of  beef,  so  frequently  given  in  the 
low  stages  of  fever,  and  in  the  exhaustion  con- 
sequent upon  severe  injuries  and  operations, 
is  prepared  by  cutting  from  a  quarter  to  half 
a  pound  of  lean  beef  into  thin  pieces,  and 
putting  it  into  a  wide-mouthed  porter  bottle, 
corked  tightly,  and  placed  in  a  kettle  of  cold 
water,  which  is  then  heated  till  it  boils.  After 
it  has  been  digested  in  this  way  for  a  few  hours, 
the  juice  is  decanted,  and  seasoned  with  salt 
and  pepper,  wine  or  brandy. 

Beef  tea,  much  less  nourishing  than  beef 
essence,  is  made  by  putting  a  quarter  of  a 
pound  of  lean  beef  in  a  pint  and  a  half  of 
water,  and  boiling  it  for  fifteen  minutes,  a 
few  blades  of  mace  being  added  during  the 
process,  and  the  fluid  well  skimmed. 

To  make  chicken   broth   requires   half  a 


MILITARY    SURGERY.  179 

young  chicken  and  a  quart  of  cold  water, 
with  a  teaspoonful  of  rice  or  barley,  the 
whole  being  slowly  boiled  for  two  hours 
under  cover,  with  proper  skimming. 

Chicken  jelly  is  prepared  by  putting  a 
chicken,  cut  up  and  all  the  bones  broken,  in 
a  stone  jar,  closely  covered,  and  retained  in 
boiling  water  for  three  hours  and  a  half.  The 
liquor  is  then  strained,  and  seasoned  with  salt 
and  mace. 

Vegetable  soup  is  composed  of  two  Irish 
potatoes,  one  onion,  and  a  piece  of  bread, 
with  a  quart  of  water,  boiled  down  to  a  pint 
in  a  closely- covered  vessel,  a  little  celery  or 
parsley  being  introduced  near  the  close  of  the 
operation.  Salt  and  pepper  are  added  at 
pleasure. 

To  form  rice  jelly  a  quarter  of  a  pound  of 
rice  flour  and  twice  that  quantity  of  loaf 
sugar  are  boiled  in  a  quart  of  water  until  the 
whole  becomes  a  glutinous  mass,  when  the 
jelly  is  strained  off  and  flavored. 

Sago  jelly  is  composed  of  four  tablespoonsful 
of  sago,  one  quart  of  water,  juice  and  rind  of 
one  lemon,  and  enough  sugar  to  render  it 


180  A   MANUAL   OP 

agreeable.  After  the  mixture  has  stood  half 
an  hour,  it  is  boiled  until  all  the  particles  are 
entirely  dissolved,  the  mass  being  constantly 
stirred. 

Oatmeal  gruel  is  composed  of  two  large 
spoonsful  of  oatmeal  and  half  a  pint  of  milk, 
stirred  into  one  pint  of  boiling  water,  and 
allowed  to  simmer  for  thirty  minutes,  when  it 
is  strained  through  a  hair  sieve.  Cornmeal 
gruel  is  prepared  in  a  similar  manner. 

Arrow-root  pap  consists  of  a  large  table- 
spoonful  of  this  substance  made  into  a  paste 
with  a  little  cold  water,  which  is  then  stirred 
into  a  pint  of  boiling  water,  and  kept  on  the 
fire  for  five  minutes.  The  nourishing  proper- 
ties of  arrow-root  pap  may  be  heightened  by 
using  milk  instead  of  water  in  its  preparation. 

Milk  toast  is  often  much  relished  by  the 
sick;  and  there  is  a  very  excellent  jelly  for 
invalids  made  of  a  thinly  sliced  and  slightly 
toasted  penny  roll,  boiled  in  a  quart  of  water 
until  it  becomes  a  glutinous  mass,  when  it 
should  be  strained  upon  a  few  shavings  of 
lemon-peel. 

The   flavor    and   efficacy   of   the   various 


MILITARY    SURGERY.  181 

dietetic  preparations  here  described  may  be 
greatly  increased  by  the  addition  of  mace, 
lemon,  wine,  or  brandy.  When  salt,  or  salt 
and  pepper  are  used,  the  patient's  own  taste 
should  be  consulted.  Great  care  should  be 
employed  in  making  these  compounds  that 
they  are  not  scorched.  To  prevent  this  a 
double  boiler  should  be  used. 

Milk-punch9  an  excellent  article  when  a 
stimulant  is  required  in  conjunction  with  a 
nutrient,  is  made  by  mixing  good  brandy  with 
cold,  fresh  milk,  in  the  proportion  of  about  one 
ounce  of  the  former  to  half  a  pint  of  the  lat- 
ter. Sugar  and  nutmeg  may  be  added  to 
make  the  mixture  palatable. 

Wine-whey,  well  made,  may  be  rendered 
of  great  service  to  the  sick.  It  is  prepared 
by  adding  to  a  pint  of  fresh  milk,  as  soon  as 
it  reaches  the  boiling  point,  as  much  good 
Madeira  or  sherry  as  will  coagulate  it.  The 
mixture  is  then  strained,  and  sweetened  or 
flavored  for  use. 

The  best  wines  for  the  sick  are  Madeira, 
port,  and  sherry.  In  cases  of  gastric  irrita- 
tion, champagne  sometimes  produces  an  ex- 
16* 


182       A   MANUAL   OF   MILITARY    SURGERY. 

cellent  effect,  quieting  the  stomach  as  well  as 
the  system  at  large. 

Egg-nog  consists  of  an  egg,  the  white  and 
yolk  of  which  are  beaten  up  separately;  half 
a  pint  of  cold  water  with  a  little  loaf-sugar  is 
then  added,  together  with  two  tablespoonsful 
of  brandy. 


APPENDIX. 


REGULATIONS  FOR  THE  ADMISSION  OF  PHYSICIANS  INTO 
THE  MEDICAL  STAFF  OF  THE  ARMY. 

THE  subjoined  regulations  respecting  the  admis- 
sion of  Medical  Men  into  the  Army  of  the  United 
States,  and  the  pay  of  Army  Surgeons,  were  issued 
by  the  War  Department  in  March,  1857  : — 

No  person  can  receive  the  appointment  of  ASSIST- 
ANT SURGEON  in  the  ARMY  OF  THE  UNITED  STATES, 
unless  he  shall  have  been  examined  and  approved 
by  an  ARMY  MEDICAL  BOARD,  to  consist  of  not  less 
than  three  SURGEONS  or  ASSISTANT  SURGEONS,  to  be 
designated  for  that  purpose  by  the  Secretary  of 
War;  nor  can  any  person  receive  the  appointment 
of  SURGEON  IN  THE  ARMY  OF  THE  UNITED  STATES, 
unless  he  shall  have  served  five  years  as  an  ASSIST- 
ANT SURGEON,  and  unless,  also,  he  shall  have  been 
examined  by  an  ARMY  MEDICAL  BOARD,  constituted 
as  aforesaid. 

BOARDS  OF  MEDICAL  EXAMINERS  are  convened  at 
such  times  as  the  wants  of  the  service  render  it 
necessary,  when  selections  are  made  by  the  Secre- 
tary of  War  of  the  number  of  applicants  to  be  ex- 

(183) 


184  APPENDIX. 

amined  for  appointment  of  ASSISTANT  SURGEON.  To 
the  persons  thus  selected,  invitations  are  given  to 
present  themselves  to  the  BOARD  for  examination. 
These  invitations  state  the  time  and  place  of  meeting 
of  the  BOARD. 

APPLICANTS  must  be  between  21  and  28  years  of 
age.  The  BOARD  will  scrutinize  rigidly  the  moral 
habits,  professional  acquirements,  and  physical  quali- 
fications of  the  candidates,  and  report  favorably  in 
no  case  admitting  of  a  reasonable  doubt. 

The  BOARD  will  report  the  respective  merits  of 
the  candidates  in  the  several  branches  of  the  exam- 
ination, and  their  relative  merit  from  the  whole ; 
agreeably  whereto,  if  vacancies  happen  within  two 
years  thereafter,  they  will  receive  appointments  and 
take  rank  in  the  Medical  Corps. 

AN  APPLICANT  failing  at  one  examination,  may  be 
allowed  a  second,  after  two  years ;  but  never  a  third. 

APPLICATIONS  must  be  addressed  to  the  SECRE- 
TARY OF  WAR  ;  must  state  the  residence  of  the  appli- 
cant, and  the  date  and  place  of  his  birth.  They 
must  also  be  accompanied  by  respectable  testimo- 
nials of  his  possessing  the  moral  and  physical  quali- 
fications requisite  for  filling  creditably  the  responsi- 
ble station,  and  for  performing  ably  the  arduous  and 
active  duties  of  an  officer  of  the  Medical  Staff. 

No  ALLOWANCE  is  made  for  the  expenses  of  per- 
sons undergoing  these  examinations,  as  they  are  in- 
dispensable prerequisites  to  appointment ;  but  those 
who  are  approved  and  receive  appointments  will  be 
entitled  to  transportation  on  obeying  their  first  order. 


APPENDIX. 


185 


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oo      ^      ^ 

No.  of  rations  per  day. 

-J 
to 

£ 

to     o>      o 

Amount  of  rations  per 
month. 

No.  of  horses  for  which  for- 

CO 

co 

H-»        M        l-i 

age  is  allowed. 

K 

S 

.        00       9 

Amount  for  forage  per 
month. 

No.  for  which  pay  is 

to 

tO 

M      .M     .M 

allowed. 

M 

Amount  allowed  for 

^ 

^ 

to     to     to 

pay  per  month. 

w 

Ci 

to     to     ^ 

CD 

Amount  allowed  for       g 

8 

§ 

5    S    § 

clothing  per  month.       < 

Amount  allowed  for       « 

co 

CC 

000 

rations  per  month. 

£ 

ft 

888 

Total  amount  allowed 

8 

8 

§  §  § 

per  month. 

to 

M 

M       M       12 

CO 

CO        ^        g 

Aggregate  amount  receiv- 

8 

8 

8    S    S 

able. 

186  APPENDIX. 

The  allowance  for  forage  and  servants  is  paid  to 
the  Surgeons  and  Assistant  Surgeons  only  when  they 
actually  employ  and  keep  in  service  the  number  of 
servants  and  horses  charged  for. 

In  addition  to  the  above,  Surgeons  and  Assistant 
Surgeons  are  allowed  an  additional  ration  per  day, 
after  the  termination  of  every  five  years'  service. 

The  Surgeons  and  Assistant  Surgeons  of  the  Vol- 
unteer Military  service  are  commissioned  by  the  Gov- 
ernor of  the  State  in  which  they  are  enrolled,  their 
appointment  being  received  either  directly  from  him 
or  from  the  officers  of  their  regiment.  It  is  obvious 
that  the  candidates  for  admission  should  be  subjected 
to  a  rigid  examination  before  a  competent  Medical 
Board;  and  there  is  reason  to  believe  that,  in  view  of 
the  great  importance  of  the  subject,  such  a  Board  will 
soon  be  established  in  every  State.  The  pay  of  the 
Surgeons — of  whom  there  are  two  in  each  regiment, 
a  Chief  and  his  Assistant — of  the  volunteer  forces  is 
the  same  as  in  the  regular  army,  when  mustered  into 
service.  The  salary  of  the  Surgeon-General  is  $2740 
a  year. 


STROMEYER  AND  ESMARCH 

ON 

GUNSHOT    INJURIES. 


GUNSHOT  FRACTURES.     By  Dr.  Louis  STROMEYER. 

RESECTION    IN    GUNSHOT    INJURIES.       By   Dr. 

FRIEDRICH  ESMARCH. 

One  vol.  12mo.    75  cents. 

In  the  present  volume  are  combined  two  valuable  trea- 
tises on  Gunshot  Injuries,  by  eminent  German  surgeons, 
forming  a  book  that  army  surgeons  in  particular  will  prize 
highly. — Buffalo  Express. 


Dr.  Stromeyer  was  Surgeon-in-Chief  of  the  Schleswig- 
Holstein  army,  in  the  campaign  of  1849,  against  the  Danes. 
Dr.  Esmarch  ^accompanied  Dr.  Stromeyer  in  this  campaign, 
which,  if  not  on  a  very  extensive  scale,  was  yet  quite  ex- 
tensive enough  to  enable  their  intelligent  surgeons  to  fre- 
quently exercise  their  skill  and  obtain  a  practical  knowl- 
edge of  the  subjects  they  treat  of  in  this  book — one  inter- 
esting and  valuable  to  all  army  surgeons. — New  York  Post. 


MAXIMS  AND  INSTRUCTIONS 

ON   THE 

ART     OF     WAR. 


MAXIMS,  ADVICE,  AND  INSTRUCTIONS  ON  THE 
Art  of  War ;  or,  A  Practical  Military  Guide  for  the 
use  of  Soldiers  of  all  Arms  and  of  all  Countries. 
Translated  from  the  French  by  CAPTAIN  LENDT,  Di- 
rector of  the  Practical  Military  College,  late  of  the 
French  Staff,  etc.  etc. 

One  vol.  18mo.    75  cents. 


J.  B.  Lippincott  &  Co/s  Military  Publications. 


McCLELLAN'S  AEMIES  OP  EUEOPE, 

THE  ARMIES  OF  EUROPE;  comprising  descriptions  in 
detail  of  the  Military  Systems  of  England,  France,  Rus- 
sia, Prussia,  Austria,  and  Sardinia.  Adapting  their 
advantages  to  all  arms  of  the  United  States  Service. 
Embodying  the  Report  of  Observations  in  Europe  during 
the  Crimean  war,  as  Military  Commissioner  from  the 
United  States  Government  in  1855-56.  By  GEO.  B.  Mc- 
CLELLAN,  Major-General  U.S.A.  Originally  published 
under  the  direction  of  the  War  Department,  by  order  of 
Congress.  1  vol.  8vo.  Illustrated  with  a  fine  steel  Por- 
trait and  several  hundred  engravings.  $3.50. 

"  Of  the  publications  occasioned  by  the  crisis,  doubtless  the  most 
important  is  the  reissue,  in  a  form  adapted  to  general  circulation,  of 
the  great  report  on  the  armies  of  Europe  of  Geo.  B.  McClellan,  now 
commander-in-chief  of  the  armies  of  the  United  States."—  The  Metho- 
dist. 

"The  young  captain  of  calvary  is  now  a  major-general,  and  to  his 
hands  the  destinies  of  our  nation  are  in  a  great  measure  intrusted ; 
and  his  book  will  now  be  recognized  as  a  popular  necessity,  and  find 
its  way  into  the  hands  of  the  multitude."— New  York  Times. 

"  The  work  contains  all  that  vast  body  of  detailed  information  per- 
taining to  the  equipment,  direction,  and  care  of  our  military  forces, 
which  is  actually  indispensable  to  every  officer  in  the  army,  and  may 
be  of  the  greatest  service  to  every  private  in  the  ranks." — Boston 
Transcript. 

"The  book  is  invaluable  to  military  men  from  the  technical  in- 
formation and  the  sagacious  views  it  presents.  It  is  of  the  greatest 
interest  to  the  public  in  general,  from  the  striking  revelation  it  makes 
ot  the  character  and  genius  of  its  modest  and  gifted  author." — Boston 
Journal. 

"The  volume  will  be  of  great  importance  to  the  host  of  young 
officers  who  are  ambitious  to  excel  in  the  art  or  profession  to  which 
they  have  now  devoted  themselves." — New  York  Sun. 


McCLELLAN'S 

MANUAL  OF  BAYONET  EXERCISES. 

PREPARED    FOR    THE    USE    OP 

THE  AR1VCY  OF  THE  UNITED  STA.TES. 
BY  GEORGE  B.  McCLELLAN, 

MAJOR-GENERAL  U.  8.  ARMY. 

Printed  by  order  of  the  'War  Department. 
One  vol.  12mo.     $1.25. 

HEADQUARTERS  OF  THE  ARMY,  Washington,  D.C. 
HON.  C.  M.  CONRAD,  Secretary  of  War. 

SIR:  Herewith  I  have  the  honor  to  submit  a  system  of  Bayonet  Ex- 
ercises, translated  from  the  French  by  Capt.  Geo.  B.  McClellan,  Corps 
Engineers,  U.  S.  Army. 

I  strongly  recommend  its  being  printed  for  distribution  to  the 
Army;  and  that  it  be  made,  by  regulation,  a  part  of  the  system  of 
instruction. 

The  inclosed  extracts  from  reports  of  the  Inspector-General,  etc., 
nhow  the  value. 

I  have  the  honor  to  be,  sir,  with  high  respect,  your  most  obedient 
servant,  WINFIELD  SCOTT. 

R.  JONES,  Adjutant-General. 
Approved.    C.  M.  CONRAD,  Secretary  of  War. 


McCLELLAN'S 

EUROPEAN    CAVALRY. 

EUROPEAN  CAVALRY,  including  details  of  the  organi- 
zation of  the  Cavalry  Service  among  the  principal  na- 
tions of  Europe;  comprising  England,  France,  Russia, 
Prussia,  Austria,  and  Sardinia.  By  GEO.  B.  MCCLELLAN, 
Major-General  U.  S.  Army. 

One  vol.  12mo.    Fully  illustrated.     $1.25. 


McCLELLAN'S 

UNITED  STATES  CAVALRY. 


REGULATIONS  AND  INSTRUCTIONS  FOR  THE 
FIELD  SERVICE  of  the  United  States  Cavalry  in  Time 
of  War. 

BY   GEO.   B.   McCLELLAN, 

MAJOR-GENERAL  U.  S.  ARMY. 

One  vol.  12mo.     Fully  Illustrated.     $1.50. 

To  which  is  added  the  Basis  of  Instruction  for  the  U.  S. 
Cavalry,  from  the  Authorized  Tactics, —  including  the 
formation  of  regiments  and  squadrons,  the  duties  and 
posts  of  officers,  lessons  in  the  training  and  use  of  the 
horse, — illustrated  by  numerous  diagrams,  with  the  sig- 
nals and  calls  now  in  use.  Also,  instructions  for  officers 
and  non-commissioned  officers  on  outpost  and  patrol 
duty.  With  a  drill  for  the  use  of  cavalrv  as  skirmishers, 
mounted  and  dismounted. 

"  The  volume  is  a  complete  manual  for  this  arm  of  the  service,  and 
Its  value  cannot  be  overrated.  Gen.  McClellan  enjoyed  almost  nn- 
equaled  facilities  for  perfecting  himself  in  a  knowledge  of  the  modern 
European  systems  of  tactics  while  a  member  of  the  Commission  sent 
by  our  Government  to  the  Old  World,  and  he  has  concentrated  the 
results  of  his  observations  within  this  volume.  No  work  on  the 
subject  could  have  more  weight,  and  we  can  think  of  none  which 
will  be  more  useful  while  the  country  is  prosecuting  the  war  for  its 
existence." — Evening  Bulletin. 

"The  precepts  contained  in  this  volume  are  applicable  to  every 
detail  of  duty  which  cavalry  may  be  expected  to  perform  in  time  of 
war  in  the  field.  It  could  not,  therefore,  be  more  valuable  or  more 
timely  than  at  present."  *  *  *  "  Every  cavalry  soldier  should 
have  it  in  his  hands."— North  American. 

"  We  question  whether  ever  before,  in  the  same  compass,  so  much 
practical  information  on  the  cavalry  arm  of  war  was  collected.  It  is 
a  thoroughly  complete  vade  mecum  for  every  mounted  soldier  in  the 
service." — The  Press- 


HARDEE'S  TACTICS. 


Rifle  and  Light  Infantry  Tactics, 

L-'or  the  Exercise  and  Manoeuvres  of  Troops  when 
acting  as  Light  Infantry  or  Riflemen. 

Prepared  under  the  direction  of  the  War  Department, 

By  Brevet  Lieutenant-Colonel  W.  J.  HAKDEE, 

U.S.A. 

Two  Vols.  complete. 


VOL.   I. 

Schools  of  the  Soldier  and  Company;  Instruc- 
tion for  Skirmishers. 

VOL.  II. 
School  of  the  Battalion. 


This  work  is  a  careful  revision  of  the  rifle  and  light  in- 
fantry tactics  for  the  exercise  and  manoeuvres  of  troops 
when  acting  as  light  infantry  or  riflemen.  It  was  prepared, 
under  the  direction  of  the  War  Department,  by  Brevet 
Lieutenant-Colonel  WM.  J.  HARDEE,  late  Tactical  Instructor 
at  West  Point.  Hardee's  Tactics  have  been  adopted  as  the 
text-book  in  the  military  establishments  of  nearly  every 
State  in  the  Union,  and  hold  a  high  rank  among  military 
men  as  of  great  practical  utility  in  the  light  infantry  arm. 
The  work  is  prepared  in  a  clear  and  lucid  manner  and  with 
numerous  pictorial  illustrations.  The  famous  Chicago 
Zouave  drill  is  essentially  Hardee's  tactics,  with  the  excep- 
tion of  some  few  fancy  movements  of  no  utility  except  to 
give  a  finish  to  an  exhibition  drill.  The  work  is  printed  in 
clear  type,  and  is  invaluable  as  a  book  of  instruction  to  our 
volunteer  corps. — New  York  Herald.  Jan.  28.  1861. 

99 


ORDNANCE  MANUAL 


THE   ORDNANCE  MANUAL, 

For  the  use  of  the  Officers  of  the  Army  and  others, 

PREPARED  UNDER  THE  DIRECTION  OF  THE  WAR  DEPARTMENT. 

Third  edition.    One  vol.  demi-8vo     tfully  illustrated 
with  Engravings  on  steel.    $2.50. 

CONTENTS.— Chap.  I.  Ordnance.  II.  Shot  and  Shell. 
III.  Artillery  Carriages.  IV.  Machines,  etc.  for  Siege 
and  Garrison  Service.  V.  Artillery  Implements  and 
Equipments.  VI.  Artillery  Harness  and  Cavalry  Equip- 
ments. VII.  Paints,  Lackers,  etc.  VIII.  Small  Arms, 
Swords,  and  Accoutrements.  IX.  Gunpowder,  Lightning 
Rods.  X.  Ammunition  of  all  kinds,  Fireworks.  XL 
Equipment  of  Batteries  for  Field,  Siege,  and  Garrison 
Service.  XII.  Mechanical  Manoeuvres.  XIII.  Artillery 
Practice,  Ranges,  Penetration,  etc.  XIV.  Materials, 
Strength  of  Materials.  XV.  Miscellaneous  information, 
Tables  of  Weights  and  Measures,  Physical  Data,  Mathe- 
matical Formulae,  Ballistics,  Tables,  etc. 

ORDNANCE  DEPARTMENT, 

WASHINGTON,  Nov.  4, 1861. 
iON.  S.  CAMERON,  Secretary  of  War. 

It  Is  respectfully  recommended  that  the  revised  edition  of  the  Old- 
Nice  Manual  be  published  for  the  use  of  the  Army. 

WILLIAM  MAYNADIER, 
Lt.  Col.  tf  Ordnance  in  charge  of  Bureau 
Approved,  Nov.  4, 1861. 
THOMAS  A.  SCOTT, 

Acting  Secretary  of  War. 

This  most  valuable  work  to  persons  engaged  in  the  military  sorv- 
ice  and  in  the  preparation  of  any  of  the  various  military  supplies 
(the  construction  of  which  is  given  in  minute  detail,)  will  also  prove 
useful  to  mechanics  generally  for  the  valuable  tables  and  miscellane- 
ous information  which  it  contains. 


DUFFIELD'S 

SCHOOL  OF  THE  BRIGADE. 


SCHOOL  OF  THE  BRIGADE,  AND  EVOLUTIONS 
of  the  Line ;  or,  Rules  for  the  Exercise  and  Manoeu- 
vres of  Brigades  and  Divisions.  Designed  as  a  Se- 
quel to  the  United  States  Infantry  Tactics,  adopted 
May  1,  1861.  By  WILLIAM  W.  DUFFIELD,  Acting 
Brigadier-General  Twenty-third  Brigade,  and  Colonel 
Ninth  Michigan  Infantry. 

One  vol.  18mo.     75  cents. 


MAJOR  MORDECAI'S  REPORT. 


HTi1  TW  MTTTTAPV 
UJ  InJij  MlijliAiU 

IN  1855  AND  1856. 

BY  MAJOR  MORDECAF,  OF  THE  ORDNANCE  DEPARTMENT. 
To  which  is  appended 

HifLed    Infantry    .A.rm.Sc 

A  BRIEF  DESCRIPTION  OF  THE  MODERN  SYS- 
tem  of  Small  Arms,  as  adopted  in  the  various  Euro- 
pean Armies.  By  J.  SCHON,  Captain  in  the  Royal 
Saxon  Infantry,  etc.  etc.  Second  edition,  revised  and 
augmented  with  Explanatory  Plates.  Translated  from 
the  German  by  J.  GORGAS,  Capt.  of  Ordnance,  U.S.A. 
One  vol.  4to.  Numerous  Engravings.  $3.50. 


SCHALK'S 
A.RT     OF 


SUMMARY  OF  THE  AIIT  OF  WAR.  Written  ex- 
pressly for,  and  dedicated  to,  the  United  States  Vol- 
unteer Army.  By  EMIL  SCHALK,  Officer  of  Artil- 
lery. 

One  vol.  12mo.    Illustrated  with  beautifully-engraved 
Maps,  Plates,  and  Diagrams.     $1.50. 

"  Mr.  Schalk,  in  our  humble  opinion,  has  admirably  suc- 
ceeded. He  has  here,  in  language  simple  and  readily  com- 
prehended, unvailed  the  whole  mystery  of  strategy,  tactics, 
grand  tactics,  mixed  operations,  and  logistics,  including 
copious  historical  and  professional  descriptions  of  some  of 
the  most  celebrated  battles,  marches,  and  sieges  of  modern 
times,  with  numerous  original  diagrams  and  maps  of  the 
greatest  interest.  Mr.  Schalk's  first  grand  example  of 
strategy  is  the  war  in  the  United  States,  presupposing  the 
movements,  on  both  sides,  of  the  campaign  now  actually  in 
progress.  The  results  at  which  the  writer  arrives  are  so 
utterly  at  variance  with  popular  ideas  on  the  subject,  and 
yet  so  astonishingly  in  consonance  with  the  actual  state  of 
our  military  chess-board,  that  the  reflecting  reader  will  be 
startled  at  their  resemblance  to  a  fixed  prediction.  The 
positions  and  forces  of  the  opposing  armies,  both  east  and 
west,  are  given  with  singular  accuracy,  and  the  very  battle- 
fields which  have  just  become,  or  are  becoming  memorable, 
are  marked  beforehand.  The  diagrams  accompanying  this 
part  of  the  work  are  extremely  interesting,  especially  those 
covering  the  region  of  Yorktown  and  Fredericksburg." — N. 
Y.  TIMES. 


JOMINI'S 
.A.IRT    OIF 


THE  ART  OF  WAR.  By  BARON  D.  JOMINI,  General  and 
Aid-de-Camp  of  the  Emperor  of  Russia.  A  New  Edi- 
tion, with  Appendices  and  Maps.  Translated  from  the 
French  by  Capt.  GL  H.  MENDELL,  U.S.A.,  Corps  of  Topo- 
graphical Engineers,  and  Lieut.  W.  P.  CRAIGHILL,  U.S.A., 
Corps  of  Engineers. 

One  vol.  demi  8vo.    $1.50. 

SUMMARY  OP  CONTENTS. 

CHAP.  I.—  Policy  of  War.  II.  Military  Policy  or  the  Philosophy  of 
War.  in.  Strategy.  IV.  Grand  Tactics  and  Battles.  V.  Of  Dif- 
ferent mixed  Operations  which  participate  at  the  same  time  of 
Strategy  and  Tactics.  VI.  Logistics,  or  the  Practical  art  of  moving 
Armies.  VII.  The  Formation  and  Employment  of  Troops  for 
Combat.  Conclusion.  SUPPLEMENT.  APPENDICES. 


MAEMONT'S 
MILITARY  INSTITUTIONS. 

THE  SPIRIT  OF  MILITARY  INSTITUTIONS,  from 
the  latest  Paris  edition.  Translated,  with  Notes,  by 
HENRY  COPPEE,  Professor  in  the  University  of  Pennsyl- 
vania, and  late  a  Carttain  in  the  Army  of  the  United 
States.  1  vol.  12mo.  $1.00. 

This  book  contains,  in  a  sman  compass,  the  principles  of  the  art  of 
war,  as  learned  and  practiced  by  this  great  marshal  during  the  Napo- 
leonic wars.  It  treats  of  strategy,  tactics,  and  grand  tactics ;  of  the 
organization  and  formation  of  armies;  the  principles  of  fortification; 
of  military  justice ;  wars  offensive  and  defensive;  marches  and  en- 
campments, reconnoissances,  battles;  and  various  important  topics, 
fncluding  the  tactics  of  the  three  arms,  as  applied  in  actual  move- 
ments before  the  enemy, — with  the  peculiar  characteristics  and  duties 
of  general  officers. 


INSTRUCTION  IN  FIELD  ARTILLERY, 

Prepared  by  a  Board  of  Artillery  Officers. 

ONE  VOL.  8vo.    $2.50. 


BALTIMORE,  MD.,  Jan.  15,  1859. 
Col.  S»  COOPER,  Ad;t.-Gen.  U.S.A. 

Sir : — The  Light  Artillery  Board  assembled  by  Special 
Orders  No.  134,  of  1856,  and  Special  Orders  No.  116,  of 
1858,  has  the  honor  to  submit  a  revised  system  of  Light 
Artillery  Tactics  and  Regulations  recommended  for  that 
arm. 

WM.  H.  FRENCH,  Bt.  Major,  Capt.  First  Artillery. 

WILLIAM  F.  BARRY,  Capt.  Second  Artillery. 

HENRY  J.  HUNT,  Bt.  Major,  Capt.  Second  Artillery. 

CAVALRY  TACTICS. 

PUBLISHED  BY  ORDER  OF  THE  WAR  DEPARTMENT. 

First    Part: 

School  of  the  Trooper;  of  the  Platoon  and  of  the 
Squadron  Dismounted. 

Second.   Part  I 
Of  the  Platoon  and  of  the  Squadron  mounted. 

Third    Part: 

Evolutions  of  a  Regiment. 

Tliree  "Vols.    ISrno.     $3.5O. 

WAR  DEPARTMENT,  Washington,  Feb.  10,  1841. 
The  system  of  Cavalry  Tactics  adapted  to  the  organiza- 
tion of  Dragoon  regiments,  having  been  approved  by  the 
President  of  the  United  States,  is  now  published  for  the 
government  of  the  said  service. 

Accordingly,  instruction  in  the  same  will  be  given  after 
the  method  pointed  out  therein  ;  and  all  additions  to  or 
departures  from  the  exercises  and  manoeuvres  laid  down  in 
this  system  are  positively  forbidden. 

J.  R.  POINSETT,  Secretary  of  War. 
100 


COOKE'3 
U.  S.  CAVALRY  TACTICS. 

/ 

Cavalry  Tactics;  or  Regulations  for  the  Instruction,  Form- 
ations, and  Movements  of  the  Cavalry  of  the  Army  and 
Volunteers  of  the  United  States.  Prepared  under  the 
direction  of  the  War  Department,  and  authorized  and 
adopted  by  the  Secretary  of  War,  Nov.  1st,  1861. 

BY  PHILIP  ST.  GEO.  COOKE, 

BRIG.  GEN.  IT.  8.  ARMY. 

In  two  vols.  18mo.    Price  $1.50. 

Vol.  I. — School  of  the  Trooper,  of  the  Platoon,  and  of 
the  Squadron. 
Vol.  II. — Evolutions  of  a  Regiment  and  of  the  Line. 


THE  SOLDIER'S  HANDY-BOOK. 

THE  HANDY-BOOK  FOR  THE  U.  S.  SOLDIER,  ON 
coming  into  Service.  Containing  a  complete  System  of 
Instruction  in  the  School  of  the  Soldier;  embracing  the 
Manual  for  the  Rifle  and  Musket,  with  a  preliminary  ex- 
planation of  the  Formation  of  a  Battalion  on  Parade,  the 
Position  of  the  Officers,  etc.  etc.  Also,  Instructions  for 
Street  Firing.  Being  a  First  Book  or  Introduction  to 
the  authorized  United  States  Infantry  Tactics. 

Complete  in  one  vol.  128  pages,  illustrated.    25  cts. 

To  the  recruit  just  mustered  into  service,  the  system  of  tactic* 
•eenis  extensive  and  difficult. 

The  design  of  this  little  Handy-Book  is  to  divide  the  instruction 
and,  by  presenting  a  complete  system  for  the  drill  of  the  individual 
soldier,  to  prepare  him  for  the  use  and  study  of  the  authorized 
United  States  Infantry  Tactics,  in  the  school  of  the  company  and  the 
battalion. 


[BY    AUTHOKITY.] 


ST-A-TIES 

INFANTRY   TACTICS: 

FOR  THE  INSTRUCTION,  EXERCISE,  AND  MAN- 
(EUVRES  OF  THE  U.  S.  INFANTRY,  including  In- 
fantry of  the  Line,  Light  Infantry,  and  Riflemen.  Pre- 
pared under  the  direction  of  the  War  Dapartment,  and 
authorized  and  adopted  by  SIMON  CAMERON,  Secretary  of 
War.  Containing  The  School  of  the  Soldier;  The  School 
of  the  Company;  Instruction  for  Skirmishers;  The  Gen- 
eral Calls ;  The  Calls  for  Skirmishers,  and  the  School  of 
the  Battalion ;  including  a  Dictionary  of  Military  Terms. 
One  volume,  complete  illustrated  with  numerous  Engrav- 
ings. $1.25. 

WAS  DEPARTMENT,  Washington,  May  1, 1861. 
This  System  of  United  States  Infantry  Tactics  for  Light  Infantry 
and  Riflemen,  prepared  tinder  the  direction  of  the  War  Department, 
having  been  approved  by  the  President,  is  adopted  for  the  instruction 
of  the  troops  when  acting  as  Light  Infantry  or  Riflemen,  and,  under 
the  act  of  May  12, 1820,  for  the  observance  of  the  militia  when  so  em- 
ployed. SIMON  CAMERON,  Secretary  of  War. 


INSTRUCTIONS  FOR 

OUTPOST  AND  PATROL  DUTY. 

Instructions  for  Officers  and  Non-commissioned  Officers  ot 
Outpost  and  Patrol  Duty,  with 

THE  SKIRMISH  DRILL 

for  Mounted  Troops.     Authorized  and  adopted  by  the 
Secretary  of  War,  Sept.  2d,  1861.     Price  25  cents. 

»       *       *       *        All  Colonels,  and  others  in  authority,  will  see 
it  that  their  commands  are  instructed  in  these  duties.    *    *    *    * 
SIMON  CAMERON,  Secretary  of  War. 


J8®-  The  Medical  and  Surgical  Books  in  this  Cata- 
logue have  been  adopted  by  the  U.  S.  Army  Medical 
Department,  for  issue  to  Field  and  General  Hospitals. 


POWER'S 

ANATOMY  OF  THE  ARTERIES. 


ANATOMY  OF    THE  ARTERIES  OF  THE  HUMAN 

Body,  Descriptive  and  Surgical,  with  the  Descriptive 
Anatomy  of  the  Heart.  By  JOHN  HATCH  POWER, 
M.D.,  Fellow  of  the  Royal  College  of  Surgeons,  Sur- 
geon to  the  City  of  Dublin  Hospital,  etc.  etc.  12mo, 
amply  illustrated.  $2.00. 


TREATISE  ON  MILITARY  HYGIENE. 

A  TREATISE  ON  HYGIENE,  WITH  SPECIAL  REF- 
erence  to  the  Military  Service.  By  WILLIAM  A. 
HAMMOND,  M.  D.,  Surgeon-General  U.  S.  Army. 
[In  Press.] 

HOSPITAL  STEWARD'S  MANUAL 

THE  HOSPITAL  STEWARD'S  MANUAL:  A  Book 
of  Instruction  for  Jlospital  Stewards,  Ward  Masters, 
and  Attendants  in  their  several  duties.  Prepared  in 
strict  accordance  with  existing  regulations  and  the 
customs  of  service  in  the  armies  of  the  United  States 
of  America.  By  JOSEPH  JANVIER  WOODWARD,  M.D., 
Assistant  Surgeon  U.S.A.  12mo.  $1.25. 


GUTHBJE'S 
SURGERY   OP  WAR. 


COMMENTARIES  ON  THE  SURGERY  OF  THE  WAR 

IN  PORTUGAL,  SPAIN,  FRANCE,  AND  THE  NETHERLANDS, 

From  the  battle  of  Rolica,  in  1808,  t&  that  of  Waterloo,  in 
1815,  with  additions  relating  to  those  in  the  CRIMEA, 
in  1854-55 ;  showing  the  improvements  made  during  and 
since  that  period  in  the  great  art  and  science  of  Surgery 
on  all  the  subjects  to  which  they  relate. 

BY  G.  J.  QUTHRIE,  F.R.S. 

One  vol.  12mo.    Price  $2.25. 

[FROM  THE  PREFACE  TO  THE  SIXTH  LONDON  EDITION.] 
"The  rapid  sale  of  the  fifth,  and  the  demand  for  a  sixth  edition  of 
this  work,  enable  me  to  say  that  the  precepts  inculcated  in  it  have 
been  fully  borne  out  and  confirmed  by  the  practice  of  the  Surgeons 
of  the  Army  in  the  Crimea  in  almost  every  particular.  *  *  * 
They  have  performed  operations  of  the  greatest  importance,  at  my 
suggestion,  that  had  not  been  done  before,  with  a  judgment  and  abil- 
ity beyond  all  praise;  and  they  have  modified  others,  to  the  great 
advantage  of  those  who  may  hereafter  suffer  from  similar  injuries. 

"  The  precepts  laid  down  are  the  result  of  the  experience  acquired 
in  the  war  in  the  Peninsula,  from  the  first  battle  of  Roli§a,  in  1808,  to 
the  last  in  Belgium,  of  Waterloo,  in  1815,  which  altered,  nay,  over- 
turned, nearly  all  those  which  existed  previously  to  that  period,  on 
all  the  points  to  which  they  relate, — points  as  essential  in  the  sur- 
gery of  domestic  as  in  military  life.  They  have  been  the  means  of 
saving  the  lives,  and  of  relieving,  if  not  even  of  preventing,  the  mis- 
eries of  thousands  of  our  fellow-creatures  throughout  the  civilized 
world." 


MACLEOD'S 

SURGERY  OFJTHE^RIWIEAN  WAR. 

NOTES  ON  THE  SURGERY  OF  THE  WAR  IN  THE 
CRIMEA,  with  Remarks  on  the  Treatment  of  Gunshot 
Wounds.  By  GEORGE  H.  B.  MACLEOD,  M.D.,  F.R.C.S., 
Surgeon  to  the  General  Hospital  in  Camp  before  Sebas- 
topol,  Lecturer  on  Military  Surgery  in  Anderson's  Uni- 
versity, Glasgow,  etc.  etc. 

One  vol.  12mo.    $1.50. 

SUMMARY  OP  CONTENTS. 

Chap.  I. — The  History  and  Physical  Characters  of  the  Crimea.  The 
Changes  of  the  Seasons  during  the  occupation  by  the  Allies.  The 
Natives,  and  their  Diseases. 

Chap.  II. — Drainage  of  the  Camp.  Water  Supply.  Latrines.  Food. 
Cooking.  Fuel.  Clothing.  Housing.  Duty.  Effect  of  all  these 
combined  on  the  health  and  diseases  of  the  soldiers.  Hospitals. 
Distribution  of  the  Sick.  Nursing,  male  and  female.  Transport. 

Chap.  III. — The  Campaign  in  Bulgaria,  and  its  effects  on  the  subse- 
quent health  of  the  troops.  The  Diseases  which  appeared  there, 
and  during  the  Flank  March,  as  well  as  afterward  in  the  Camp  be- 
fore Sebastopol. 

Chup.lV. — Distinction  between  Surgery  as  practiced  in  the  Army  and 
Civil  Life.  Soldiers  as  Patients,  and  the  character  of  the  Injuries 
to  which  they  are  liable.  Some  peculiarities  in  the  Wounds  and 
Injuries  seen  during  the  war. 

Chap.  V.— The  "  Peculiarities"  of  Gunshot  Wounds,  and  their  General 
Treatment. 

Chap.  VI.— The  use  of  Chloroform  in  the  Crimea.  Primary  and  Sec- 
ondary Hemorrhage  from  Gunshot  Wounds.  Tetanus.  Gangrene. 
Erysipelas.  Frostrbite. 

Chap.  VII. — Injuries  of  the  Head. 

Chap.  VIII.— Wounds  of  the  Face  and  Chest. 

Chap.  IX.— Gunshot  Wounds  of  the  Abdomen  and  Bladder. 

Chap.  X. — Compound  Fracture  of  the  Extremities. 

Chap.  XI.— Gunshot  Wounds  of  Joints.    Excision  of  Joints,  etc.  etc. 

Chap.  XII. — Amputation 


LONGMOBE'S 

GUNSHOT  WOUNDS. 

A  TREATISE  ON  GUNSHOT  WOUNDS.    By  T.  LONG- 

MORE,  Deputy  Instructor  of  Hospitals,  Prof,  of  Military 
Surgery  at  Fort  Pitt,  Chatham.    In  two  Parts. 

Part,    I.  Gunshot  Wounds  in  General. 

Part  II.  Gunshot  Wounds  in  Special  Regions  of  the  Body. 

One  vol.  12mo.     75  cts. 


REVISED  ARMY  REGULATIONS. 

REVISED  REGULATIONS  FOR  THE  ARMY  OF  THE 
United  States,  1861.  By  authority  of  the  President  of 
the  United  States  and  the  Secretary  of  War.  With  a 
'ull  Index.  JUST  PUBLISHED. 

One  vol.  8vo.      1.75. 


MILITARY  ENCYCLOPEDIA. 

COMPREHENSIVE  ENCYCLOPEDIA  OF  MILI- 
tary  Science,  Art,  and  History ;  containing  a  Complete 
Explanation  of  all  Military  Terms,  with  their  Pronunci- 
ation, and  Descriptions  of  the  Principal  Battles  in  the 
World's  History.  Fully  illustrated. 

[!N  PRESS.] 


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U.C.  BERKELEY  LIBRARIES 


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IB  62 


THE  UNIVERSITY  OF  CALIFORNIA  LIBRARY 


